{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alan J Amero","gend":0,"currentgend":"","add":"SUNNYBROOK FARM RD","city":"BRIDGTON","state":"ME","zip":"04009","dob":"1952-05-22","age":"","mstatus":"","insh":"10000093562","cliId":"","pno":"6032732055","cno":"","email":"","ename":"","eno":"","pphy":"OBRIEN, RICHARD","ppno":"","pcpadd":"PO BOX 1327,","pcpcity":"LACONIA","pcpstate":"NH","pcpzip":"32471327","pcpcounty":"","pcpid":"","pcpname":"CONCORD HOSPITAL PRIMARY CARE BELMONT","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 397","madd2":"","madd3":"","mcity":"NORTH BRIDGTON","mstate":"ME","mzip":"04057","pcpfaxno":"6035277038","pcpnpi":"1518930551","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AG1PE6MM93","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F430","H25813","Z79899","Z01818","H269","M21611","Z954","H25811","H2511","M2011","M19071","M19072","M2012","H26493","H401132","H35411","H33012","H401131"],"date":["2023-05-09","2023-07-11","2023-07-13","2023-07-27","2023-07-27","2023-08-31","2023-07-27","2023-08-15","2023-08-15","2023-10-31","2023-08-31","2023-08-31","2023-10-31","2024-07-01","2024-02-26","2024-02-26","2024-02-26","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":[["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Prolensa","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Lupin","","","Select","Select",""],["","","Hydroxyzine Pam","25 MG","","Select","Select",""],["","","Ofloxacin 0.3 % Ophth Sol Apotex","","","Select","Select",""],["","","Rhopressa","","","Select","Select",""],["","","Brimonidine 0.15 % Ophth Sol Pacific","","","Select","Select",""],["","","Zolpidem","5 MG","","Select","Select",""],["","","Pantoprazole","20 MG","","Select","Select",""],["","","Prednisone","50 MG","","Select","Select",""],["","","Meloxicam","15 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":""}]}]}