{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lea A Lantagne","gend":1,"currentgend":"","add":"57 MARC DR","city":"SANFORD","state":"ME","zip":"04073","dob":"1956-09-25","age":"","mstatus":"","insh":"10000090466","cliId":"","pno":"2073246533","cno":"2074323210","email":"declined@13126.com","ename":"","eno":"","pphy":"PRAST, BRENDAN J","ppno":"2074907998","pcpadd":"\tMaineHealth Primary Care Family Medicine,\t25A June St Ste 111","pcpcity":"Sanford","pcpstate":"ME","pcpzip":"04073","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"57 MARC DR","madd2":"","madd3":"","mcity":"SANFORD","mstate":"ME","mzip":"04073","pcpfaxno":"2074907999","pcpnpi":"1043779804","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3CM4W93TC79","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F200","Z20822","J069","J208","S79912A","S32592A","E785","F209","R918","R059","J209","Z0000","Z9181","M85859","Z0101","H5213","H52223","H524","H2513","H40013","G250","B079"],"date":["2024-06-13","2023-07-24","2023-08-27","2023-08-16","2023-08-24","2023-08-24","2023-08-24","2023-08-24","2023-08-27","2023-08-27","2023-08-29","2023-09-20","2023-09-20","2023-09-20","2023-10-16","2023-10-16","2023-10-16","2023-10-16","2023-10-16","2023-10-16","2024-03-06","2024-05-31"],"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":[["","","Risperidone","4 MG","","Select","Select",""],["","","Benztropine","0.5 MG","","Select","Select",""],["","","Propranolol","10 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Risperidone Er","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Levothyroxine","112 MCG","","Select","Select",""],["","","Fluphenazine Dec","25 MG","","Select","Select",""],["","","Lurasidone","60 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 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":""}]}]}