{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janis Molleur","gend":1,"currentgend":"","add":"9 TEAL POINT DRIVE","city":"Scarborough","state":"ME","zip":"04074","dob":"1956-01-20","age":"","mstatus":"","insh":"10000086891","cliId":"","pno":"2072294706","cno":"","email":"janmolleur@gmail.com","ename":"","eno":"","pphy":"WELCH, JUDY L","ppno":"2072830500","pcpadd":"3 Eastview Pkwy,","pcpcity":"SACO","pcpstate":"ME","pcpzip":"04072","pcpcounty":"","pcpid":"","pcpname":"JUDY WELCH MD PA","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9 TEAL POINT DRIVE","madd2":"","madd3":"","mcity":"Scarborough","mstate":"ME","mzip":"04074","pcpfaxno":"2072834207","pcpnpi":"1174519235","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9QG9VN7RP45","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E6601","Z9884","Z6841","I10","E782","H2513","H35341","H5203","G4733","E669","R6889","L988","F3341","M1611","Z96653","M25551","M25569","M6281","R2689","Z713","Z6833","Z780","Z13820","Z1231","R1013","Z6832","Z98890","Z6831"],"date":["2023-09-19","2024-05-28","2023-05-23","2023-11-28","2023-05-23","2023-08-16","2023-08-16","2023-08-16","2023-11-28","2024-05-28","2023-08-27","2023-09-19","2023-09-19","2023-11-06","2023-12-01","2023-11-06","2023-12-01","2023-12-01","2023-12-01","2024-06-20","2023-11-30","2023-12-07","2023-12-07","2023-12-08","2024-05-28","2024-03-11","2024-05-02","2024-05-28"],"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":[["","","Dicloxacillin","500 MG","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Bupropion Hcl","150 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Enoxaparin Pf","30 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Sucralfate","1 GM","","Select","Select",""],["","","Pfizer-Biontech Gray","","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Oxycodone Hcl\/Acetaminophen","5\/325 MG","","Select","Select",""],["","","Topiramate","25 MG","","Select","Select",""],["","","Citalopram","20 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":""}]}]}