{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John M Romano","gend":0,"currentgend":"","add":"5B POND FIELD LN","city":"MOUNT DESERT","state":"ME","zip":"04660","dob":"1951-02-04","age":"","mstatus":"","insh":"10000075623","cliId":"","pno":"2074606997","cno":"","email":"JROMANO6666@GMAIL.COM","ename":"","eno":"","pphy":"WEISS, ROBERT D","ppno":"2073389968","pcpadd":"PO BOX 8,10 WAYMAN LANE","pcpcity":"BAR HARBOR","pcpstate":"ME","pcpzip":"46090008","pcpcounty":"","pcpid":"","pcpname":"COOPER GILMORE HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5B POND FIELD LN","madd2":"","madd3":"","mcity":"MOUNT DESERT","mstate":"ME","mzip":"04660","pcpfaxno":"2073380332","pcpnpi":"1538150503","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6NF0HC2TN13","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9903","Z4502","M25561","J370","H35342","H35373","H35433","H43823","R6889","M1711","K219","J310","J342","H608X3","G4700","N431","N5082","N451","M629","N433","E785","Z0000","I4729","H2512","H35372","H2511","H6121","Z0100","Z95810","I350","Z8679","K644","I951"],"date":["2023-04-03","2024-04-25","2023-05-26","2024-06-17","2024-07-01","2024-07-01","2023-06-27","2024-07-01","2023-05-22","2023-10-16","2023-06-12","2023-06-12","2023-06-12","2024-06-17","2023-08-07","2023-08-29","2023-08-28","2023-09-20","2023-09-20","2023-09-20","2023-12-28","2024-02-23","2024-04-17","2024-04-09","2024-03-28","2024-04-23","2024-03-29","2024-03-04","2024-04-17","2024-04-17","2024-04-17","2024-05-22","2024-06-28"],"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":[["","","Atorvastatin","40 MG","","Select","Select",""],["","","Nystop","","","Select","Select",""],["","","Hydrocortisone 2.5 % Rec Cream Ani Pharm","","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Lupin","","","Select","Select",""],["","","Trazodone","150 MG","","Select","Select",""],["","","Capvaxive","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Ramelteon","8 MG","","Select","Select",""],["","","Rosuvastatin","40 MG","","Select","Select",""],["","","Ketorolac 0.4 % Ophth Sol Pacific","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","Diclofenac Sodium","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","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":""}]}]}