{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan Moore","gend":1,"currentgend":"","add":"323 STILLWATER AVE APT 34","city":"BANGOR","state":"ME","zip":"04401","dob":"1956-06-25","age":"","mstatus":"","insh":"10000082696","cliId":"","pno":"2077459813","cno":"","email":"sumicka@yahoo.com","ename":"","eno":"","pphy":"KEITH, ALLISON C","ppno":"","pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"323 STILLWATER AVE APT 34","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":"2079735042","pcpnpi":"1285013771","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4E44YP6AT87","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S4992XA","M9903","S39012A","M9901","M9902","M25512","Z9181","Z20822","F419","M19012","M24412","R531","Z0000","N1830","R739","E039","M170","S83412A","X501XXA","M1712","R079","R002","R0789","I129","Z8249","M75122","R0981","J3089","H9319","M542","M12812","R6889","E669","F411","F331","S6992XA","S63502A","W010XXA","H538"],"date":["2023-04-20","2023-04-10","2023-04-10","2023-04-10","2023-04-10","2023-06-02","2023-04-20","2023-04-20","2024-02-09","2023-06-02","2023-06-02","2023-06-02","2024-06-25","2024-01-17","2023-06-22","2023-06-22","2024-06-13","2023-08-01","2023-08-01","2023-08-01","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-09-05","2023-09-26","2023-09-26","2024-03-26","2023-09-26","2023-10-27","2023-04-12","2024-03-26","2024-07-03","2024-07-03","2024-06-20","2024-06-20","2024-06-20","2024-06-26"],"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":[["","","Synthroid","","","Select","Select",""],["","","Celecoxib","100 MG","","Select","Select",""],["","","Hydromorphone","2 MG","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Venlafaxine","75 MG","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Desvenlafaxine Succ","50 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Rosuvastatin","10 MG","","Select","Select",""],["","","Levothyroxine","88 MCG","","Select","Select",""],["","","Dexamethasone","4 MG","","Select","Select",""],["","","Trazodone","150 MG","","Select","Select",""],["","","Zolpidem","10 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Lisinopril\/Hydrochlorothiazide","20\/12.5 MG","","Select","Select",""],["","","Prevnar 20","","","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":""}]}]}