{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan L Merrill","gend":1,"currentgend":"","add":"4 GREGORY PINES DR","city":"SEBAGO","state":"ME","zip":"04029","dob":"1951-03-11","age":"","mstatus":"","insh":"10000075503","cliId":"","pno":"2077125087","cno":"2072102403","email":"shellysue70.sm@gmail.com","ename":"","eno":"","pphy":"ACHILLE, JUSTINE","ppno":"","pcpadd":"Martins Point Health Care,PO Box 9746","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04104","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 13","madd2":"","madd3":"","mcity":"SEBAGO","mstate":"ME","mzip":"04029","pcpfaxno":"","pcpnpi":"1962962324","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8RT9TJ5XX11","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I6523","Z48812","Z95828","H35372","H04123","H52223","H538","R6889","I10","Z23","Z1231","M25552","M1612","M6281","R262","R600","M87052","H26493","Z01818","M1611","Z471","Z96642"],"date":["2023-04-25","2023-04-25","2023-04-25","2024-05-20","2023-05-17","2024-05-20","2023-07-17","2023-07-17","2023-11-15","2023-11-22","2023-11-29","2024-06-17","2024-06-17","2024-03-20","2024-03-20","2024-04-10","2024-06-17","2024-05-20","2024-05-31","2024-05-31","2024-06-27","2024-06-27"],"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":[["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Pravastatin Sodium","","","Select","Select",""],["","","Epinephrine","0.3 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Celecoxib","200 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Chlorthalidone","25 MG","","Select","Select",""],["","","Amlodipine","5 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":""}]}]}