{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nola M Denslow","gend":1,"currentgend":"","add":"301 ALLEN POINT RD","city":"HARPSWELL","state":"ME","zip":"04079","dob":"1936-05-27","age":"","mstatus":"","insh":"10000090426","cliId":"","pno":"2078330926","cno":"","email":"noladenslow10@gmail.com","ename":"","eno":"","pphy":"HOWE, TIMOTHY R","ppno":"","pcpadd":"329 MAINE ST,SUITE D","pcpcity":"BRUNSWICK","pcpstate":"ME","pcpzip":"40113310","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"301 ALLEN POINT RD","madd2":"","madd3":"","mcity":"HARPSWELL","mstate":"ME","mzip":"04079","pcpfaxno":"2077219345","pcpnpi":"1083776371","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1G17GQ3XM79","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z936","I10","I5181","I471","E042","I158","Z8679","I6523","H9319","Z0000","L570","L821","D225","L578","M9900","M9901","M9902","M5450","C679","N390","R8289","N200","R5383","M546","Z87442","M47816","F4310","G4700","G479","R609","S63681A","M7989","M19041","I4710","Z933","G459","M6281","R000","I080","R0789","L728","L814","G4730","B354","A6920"],"date":["2024-05-14","2024-06-26","2024-03-22","2023-09-08","2023-05-16","2023-05-16","2023-09-08","2023-04-24","2023-04-24","2023-05-16","2023-12-07","2024-06-03","2024-06-03","2023-05-15","2023-05-24","2023-05-24","2023-05-24","2023-11-16","2024-05-28","2023-11-17","2023-05-25","2024-06-13","2023-06-24","2023-06-23","2023-06-23","2023-06-29","2023-10-07","2023-09-15","2023-12-20","2023-12-31","2023-12-31","2023-12-31","2023-12-31","2024-06-26","2024-01-31","2024-02-06","2024-02-06","2024-02-13","2024-03-22","2024-04-03","2024-06-03","2024-06-03","2024-06-11","2024-07-03","2024-07-01"],"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":[["","","Prazosin","1 MG","","Select","Select",""],["","","Diltiazem","120 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Pacific","","","Select","Select",""],["","","Propranolol","10 MG","","Select","Select",""],["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Nifedipine","30 MG","","Select","Select",""],["","","Erythromycin 0.5 % Ophth Oint Perrigo","","","Select","Select",""],["","","Cartia Xt","","","Select","Select",""],["","","Nifedipine Er","","","Select","Select",""],["","","Metoprolol Succ","25 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":""}]}]}