{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary E Koepenick","gend":1,"currentgend":"","add":"63 COURTNEY LN","city":"ELIOT","state":"ME","zip":"03903","dob":"1943-12-29","age":"","mstatus":"","insh":"10000076119","cliId":"","pno":"6035025756","cno":"","email":"marykoepenick@yahoo.com","ename":"","eno":"","pphy":"STEVENS, MICHAEL J","ppno":"6037750000","pcpadd":"4 ALUMNI DR,","pcpcity":"EXETER","pcpstate":"NH","pcpzip":"38332118","pcpcounty":"","pcpid":"","pcpname":"CORE PRIMARY CARE PORTSMOUTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"63 COURTNEY LN","madd2":"","madd3":"","mcity":"ELIOT","mstate":"ME","mzip":"03903","pcpfaxno":"6037750247","pcpnpi":"1659415859","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8HX7GP5UC68","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1712","S80912A","W1839XA","Z23","Z0000","Z1211","E039","I10","M940","K219","I2510","E785","I25119","E871","R519","R001","R002","H539","R6889","H353132","H25813","H43813","H02882","R1032","Z6831","Z6832","R079","S4992XA","R9431","R918","R0602"],"date":["2023-04-15","2023-04-15","2023-04-15","2023-12-14","2023-04-28","2023-04-28","2024-03-11","2024-03-11","2023-05-04","2023-05-04","2024-03-14","2024-03-11","2024-04-30","2023-06-15","2023-07-14","2024-05-02","2023-07-14","2023-07-14","2023-07-14","2023-09-06","2023-09-06","2023-09-06","2023-09-06","2024-01-15","2024-01-15","2024-05-10","2024-05-10","2024-04-30","2024-04-30","2024-04-30","2024-04-30"],"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":[["","","Gavilyte-G","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","Flovent Hfa","","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Alprazolam","0.25 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Levothyroxine","88 MCG","","Select","Select",""],["","","Advair Hfa","","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Losartan","100 MG","","Select","Select",""],["","","Isosorbide Mononitrate","120 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":""}]}]}