{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Darleen A Conley","gend":1,"currentgend":"","add":"166 HARRIS AVE","city":"PORTLAND","state":"ME","zip":"04103","dob":"1955-02-23","age":"","mstatus":"","insh":"10000091556","cliId":"","pno":"2078996626","cno":"","email":"darleenconley1@gmail.com","ename":"","eno":"","pphy":"BRENNAN, KATHLEEN E","ppno":"2077811500","pcpadd":"22 BRAMHALL ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41023134","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"166 HARRIS AVE","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":"2077811507","pcpnpi":"1922444900","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8UQ9NR5HW10","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R011","I10","I7120","R5383","Z0101","H40013","Z0000","I129","N1831","R7303","Z23","L089","N898","E6609","R918","J40","R509","R059","J029","J181","J984","I77810","E7800","M1712","M25562","R2243"],"date":["2023-04-14","2024-02-29","2024-02-29","2023-04-14","2023-05-11","2023-06-22","2023-06-28","2023-06-28","2023-07-07","2023-07-07","2023-10-13","2023-10-13","2023-10-13","2023-10-13","2023-10-29","2023-12-01","2023-10-29","2023-10-29","2023-10-29","2023-12-01","2023-12-01","2024-02-01","2024-02-29","2024-05-17","2024-05-17","2024-05-17"],"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":[["","","Atorvastatin Calcium","","","Select","Select",""],["","","Cyclobenzaprine","10 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Buspirone","10 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Ciproflox\/Dexameth 0.3\/0.1 % Otic Susp Sun","","","Select","Select",""],["","","Zepbound","","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Citalopram","40 MG","","Select","Select",""],["","","Topiramate","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":""}]}]}