{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lorene E Nash","gend":1,"currentgend":"","add":"113 GRANT RD","city":"SHAPLEIGH","state":"ME","zip":"04076","dob":"1939-09-21","age":"","mstatus":"","insh":"10000075460","cliId":"","pno":2076361456,"cno":"","email":"declined@01012020.com","ename":"","eno":"","pphy":"LEE, BRENDA C","ppno":"","pcpadd":"16 PEASLEE RD,","pcpcity":"ROCHESTER","pcpstate":"NH","pcpzip":"38674523","pcpcounty":"","pcpid":"","pcpname":"NASSON OFFSITE CLINICAL CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"113 GRANT RD","madd2":"","madd3":"","mcity":"SHAPLEIGH","mstate":"ME","mzip":"04076","pcpfaxno":"","pcpnpi":1649835224,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1RM0X07YE31","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01419","N8189","N816","M546","I10","E785","Z86718","Z0101","H5203","H52223","S32511A","S32591A","H6123","M48061","S42001D","K5900","Z87891","H5712","M25511","M5124","M5134","M47814","I70203","L602","H353131","H401132","S42001A","S42031A","S32511D","R300","G629","G5793","S42001S","Z0189","M5450","R2243","Z780","S79911A","M40204","H409","E559","K5730","K449","M810","S32591D","M8589","S59911A","M47816","M549","Z0000","H903","H2512"],"date":["2024-09-10","2025-09-09","2025-09-09","2025-12-19","2026-03-23","2025-04-14","2023-06-01","2025-06-13","2025-06-13","2025-06-13","2025-07-08","2025-07-08","2025-05-29","2025-12-08","2024-06-20","2025-07-17","2025-07-17","2024-04-22","2024-05-20","2025-11-19","2025-11-19","2025-11-19","2026-02-19","2026-02-19","2025-12-12","2025-12-12","2024-05-24","2024-05-20","2025-07-28","2025-07-11","2026-01-28","2026-04-08","2024-05-28","2025-11-19","2025-11-19","2026-01-07","2024-08-07","2025-07-08","2025-10-01","2024-04-01","2024-04-01","2025-07-17","2025-07-17","2024-08-07","2025-08-05","2024-08-07","2025-06-24","2025-10-01","2025-10-01","2025-04-01","2025-07-14","2023-05-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","Latanoprost 0.005 % Ophth Sol Sandoz","","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Losartan\/Hydrochlorothiazide","100\/25 MG","","Select","Select",""],["","","Dorzolamide\/Timolol 2\/0.5 % Ophth Sol B&L","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol B&L","","","Select","Select",""],["","","Losartan-Hydrochlorothiazide","","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Duloxetine","20 MG","","Select","Select",""],["","","Pregabalin","25 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Somerset","","","Select","Select",""],["","","Trifluridine 1 % Ophth Sol Sandoz","","","Select","Select",""],["","","Zirgan","","","Select","Select",""],["","","Valacyclovir","500 MG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}