{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christiane L Casserly","gend":1,"currentgend":"","add":"35 31ST ST","city":"SHAPLEIGH","state":"ME","zip":"04076","dob":"1951-11-16","age":"","mstatus":"","insh":"10000075747","cliId":"","pno":"2076363959","cno":"2076607279","email":"chcasserly@gmail.com","ename":"","eno":"","pphy":"MICHAUD, KATHRYN","ppno":"2077998596","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"35 31ST ST","madd2":"","madd3":"","mcity":"SHAPLEIGH","mstate":"ME","mzip":"04076","pcpfaxno":"2077991730","pcpnpi":"1104353838","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6Y39XN6JK49","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":["R6889","L821","D1801","L918","L900","E119","E785","M8580","I10","R011","Z136","I352","I358","I422","I5189","I2720","Z1211","Q231","I350","I700","R079","Z48812","E669","G8918","J9811","J986","A000","J90","Q230","I110","I5032","Z01818","Z952","Z98890","M9900","M9901","M9902","M546","C44719","D492","Z0101","Z954"],"date":["2023-06-26","2023-04-05","2023-04-05","2023-04-05","2023-04-05","2024-06-24","2024-04-01","2024-06-24","2024-04-01","2023-09-21","2023-10-03","2024-03-08","2023-09-21","2023-09-21","2023-09-21","2023-11-06","2023-10-30","2024-03-08","2024-04-01","2023-11-17","2024-03-07","2024-03-15","2024-03-08","2024-03-08","2024-03-11","2024-03-09","2024-03-15","2024-03-13","2024-03-08","2024-03-08","2024-03-08","2024-03-07","2024-04-01","2024-03-25","2024-03-12","2024-03-12","2024-03-12","2024-03-12","2024-06-20","2024-04-03","2024-03-25","2024-04-22"],"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":[["","","Jardiance","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Clobetasol 0.05 % Ointment Taro","","","Select","Select",""],["","","Mupirocin 2 % Ointment Taro","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Amiodarone","200 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Furosemide","40 MG","","Select","Select",""],["","","Potassium Cl","20 MEQ","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","Select","Select",""],["","","Comirnaty 2023-2024","","","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":""}]}]}