{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brenda J Beaudoin","gend":1,"currentgend":"","add":"95 OLD SUMNER RD","city":"BUCKFIELD","state":"ME","zip":"04220","dob":"1957-06-10","age":"","mstatus":"","insh":"10000096030","cliId":"","pno":"2072120806","cno":"","email":"","ename":"","eno":"","pphy":"HUNTRESS, LAURIE A","ppno":"2075243501","pcpadd":"180 CHURCH HILL RD,STE 1","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 245","madd2":"","madd3":"","mcity":"BUCKFIELD","mstate":"ME","mzip":"04220","pcpfaxno":"2075242459","pcpnpi":"1629046693","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XG5PY2RP74","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E782","Z862","M810","Z8249","Z122","Z0101","K5732","K449","K439","R1032","F17210","Z1231","H25811","H25812","Z961","K5720"],"date":["2023-06-28","2023-06-28","2023-06-28","2023-06-28","2023-09-13","2023-11-29","2023-12-28","2023-12-28","2023-12-28","2023-12-28","2023-12-28","2024-02-14","2024-04-03","2024-04-17","2024-04-10","2024-06-13"],"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",""],["","","Etodolac","500 MG","","Select","Select",""],["","","Sulfamethoxazole\/Trimethoprim","800\/160 MG","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Pacific","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Memantine","10 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Varenicline","1 MG","","Select","Select",""],["","","Ofloxacin 0.3 % Otic Sol Somerset","","","Select","Select",""],["","","Sertraline","25 MG","","Select","Select",""],["","","Donepezil","10 MG","","Select","Select",""],["","","Varenicline 0.5;1 Mg Tab Lupin","","","Select","Select",""],["","","Dexamethasone","4 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Clindamycin","150 MG","","Select","Select",""],["","","Prolia","","","Select","Select",""],["","","Ciprofloxacin 0.3 % Ophth Sol Sandoz","","","Select","Select",""],["","","Oxycodone Hcl\/Acetaminophen","5\/325 MG","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","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":""}]}]}