{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vivian A Crocker","gend":1,"currentgend":"","add":"686 MAIN ST","city":"HARTFORD","state":"ME","zip":"04220","dob":"1953-09-29","age":"","mstatus":"","insh":"10000075968","cliId":"","pno":"2075972548","cno":"","email":"DECLINED@05312024.COM","ename":"","eno":"","pphy":"HUNTRESS, LAURIE A","ppno":"2075243501","pcpadd":"180 CHURCH HILL RD,STE 1","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"686 MAIN ST","madd2":"","madd3":"","mcity":"HARTFORD","mstate":"ME","mzip":"04220","pcpfaxno":"2075242459","pcpnpi":"1629046693","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2JY0HH8GQ39","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E113311","E113392","H43823","H26493","E1121","M5451","E109","M2141","M2142","M47816","M25551","M25552","M4727","M1611","M5450","I10","M7918","G8929","I639","I69151","E113211","I69351","I2510","I255","E1165","Z9189","I429","E039","N390","N179","E119","I5040","R0600","I6523","R079","E785","R4182","J9811","M549"],"date":["2024-11-07","2024-08-01","2023-06-19","2023-04-24","2023-05-04","2023-06-21","2025-04-08","2023-07-25","2023-07-25","2024-03-26","2023-10-24","2023-10-24","2023-10-24","2023-10-24","2024-04-25","2025-12-08","2024-04-25","2024-04-25","2025-09-10","2025-09-04","2026-01-21","2025-07-29","2025-09-10","2023-03-21","2025-03-19","2025-10-24","2026-01-08","2025-10-27","2025-07-25","2025-07-25","2025-07-25","2025-05-27","2025-05-27","2025-07-25","2025-09-10","2025-05-13","2025-07-24","2025-07-24","2025-07-24"],"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":[["","","Freestyle Libre 14 Day Reader (Ref 71938-0","","","Select","Select",""],["","","NITROGLYCERIN","0.4 MG","","Select","Select",""],["","","LISINOPRIL","5 MG","","Select","Select",""],["","","PREGABALIN","50 MG","","Select","Select",""],["","","CARVEDILOL","12.5 MG","","Select","Select",""],["","","FIASP FLEXTOUCH","","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","ISOSORBIDE MONONITRATE","60 MG","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","Freestyle Libre 14 Day Sensor (Ref 71940-0","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","LOSARTAN","25 MG","","Select","Select",""],["","","BASAGLAR KWIKPEN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","Freestyle Libre 2 Reader (Ref 71953-01)","","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","Freestyle Libre 2 Sensor","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","Freestyle Libre 2 Plus Sensor","","","Select","Select",""],["","","FREESTYLE LIBRE","2 READER","","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":""}]}]}