{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Perry A Ellsworth","gend":0,"currentgend":"","add":"195 LAMBERT HILL RD","city":"STRONG","state":"ME","zip":"04983","dob":"1950-12-10","age":"","mstatus":"","insh":"10000075847","cliId":"","pno":"2074913330","cno":"2074913330","email":"CHIPMAKER1972PERRY@GMAIL.COM","ename":"","eno":"","pphy":"BESSE, MADELYN","ppno":"2076844010","pcpadd":"Strong Area Health Center,177 North Main St","pcpcity":"Strong","pcpstate":"ME","pcpzip":"04983","pcpcounty":"","pcpid":"","pcpname":"STRONG AREA HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"195 LAMBERT HILL RD","madd2":"","madd3":"","mcity":"STRONG","mstate":"ME","mzip":"04983","pcpfaxno":"2076843368","pcpnpi":"1265404867","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3TV1CQ5XJ92","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":["I10","E1159","I25118","Z0000","Z125","E611","E039","Z0100","I080","I77810","I119","L299"],"date":["2023-08-17","2024-01-23","2024-02-05","2023-08-17","2023-08-17","2023-08-17","2023-08-17","2023-09-26","2024-01-31","2024-01-31","2024-01-31","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":[["","","Bd Nano 2 Gen","","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Atenolol","50 MG","","Select","Select",""],["","","Carvedilol","12.5 MG","","Select","Select",""],["","","Onetouch Ultra","","","Select","Select",""],["","","Rosuvastatin","40 MG","","Select","Select",""],["","","True Metrix","","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Venlafaxine","150 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Isosorbide Mononitrate","60 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","Levothyroxine","100 MCG","","Select","Select",""],["","","Novofine Autocover Insulin","","","Select","Select",""],["","","Onetouch Ultra Blue","","","Select","Select",""],["","","Lantus Solostar","","","Select","Select",""],["","","Ultra-Fine (Ref 320109)","","","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":""}]}]}