{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Laura M Morgan","gend":1,"currentgend":"","add":"1348 PARK ST","city":"LIVERMORE FALLS","state":"ME","zip":"04254","dob":"1956-09-19","age":"","mstatus":"","insh":"10000088217","cliId":"","pno":"2074411360","cno":"","email":"laurabach11@gmail.com","ename":"","eno":"","pphy":"SAGE, JOLINE A","ppno":"2075624226","pcpadd":"16 DEPOT ST SUITE 300,","pcpcity":"LIVERMORE FALLS","pcpstate":"ME","pcpzip":"04254","pcpcounty":"","pcpid":"","pcpname":"WESTERN MAINE FAMILY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1348 PARK ST","madd2":"","madd3":"","mcity":"LIVERMORE FALLS","mstate":"ME","mzip":"04254","pcpfaxno":"2078972321","pcpnpi":"1285038174","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2RA0NV4YE42","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9903","M5451","M9904","M9902","E782","R7301","R5383","R350","K529","S61452A","L03114","M62838","M25511","W5501XA","M25512","M533","J3081","S40862A","W57XXXA","Z1231","F32A","M461","J069","Z0000","R3915","K760","K820","K5900","R1084","K3580","R1031","Z9049","D72819","R1010","R109","R140","F17200","Z881","R5382","R718","D72820","D72829","R531","R1013","I440","Z87891","M25551","Z806","R079","M79605","Z1211","K219","K640","K2080","R0789","I4510","K635","H538","H53459","G9389","H543","R1011"],"date":["2024-05-17","2024-05-17","2024-05-17","2023-11-17","2023-04-26","2023-04-26","2023-05-02","2024-02-02","2023-05-15","2023-06-10","2023-06-10","2023-05-19","2023-05-19","2023-06-05","2023-06-08","2023-06-08","2023-08-01","2023-08-01","2023-08-01","2023-11-15","2023-11-17","2024-05-17","2023-12-28","2024-02-01","2024-02-16","2024-02-22","2024-02-22","2024-02-24","2024-04-25","2024-02-24","2024-02-24","2024-03-22","2024-03-11","2024-02-22","2024-02-21","2024-02-24","2024-02-24","2024-02-24","2024-03-04","2024-02-20","2024-02-24","2024-03-22","2024-02-21","2024-05-16","2024-03-20","2024-03-20","2024-02-02","2024-03-22","2024-04-11","2024-04-11","2024-04-16","2024-07-08","2024-04-16","2024-04-16","2024-04-11","2024-04-11","2024-04-16","2024-05-23","2024-06-24","2024-07-09","2024-07-09","2024-07-08"],"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":[["","","Clindamycin Hcl","","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Lansoprazole","15 MG","","Select","Select",""],["","","Amitriptyline","25 MG","","Select","Select",""],["","","Pantoprazole","20 MG","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Fosfomycin","3 GM","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Alprazolam","0.5 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Sucralfate","1 GM","","Select","Select",""],["","","Clindamycin","150 MG","","Select","Select",""],["","","Cefuroxime","500 MG","","Select","Select",""],["","","Gabapentin","600 MG","","Select","Select",""],["","","Gemfibrozil","600 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":""}]}]}