{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jeanna M Best","gend":1,"currentgend":"","add":"51 ALLISON AVE","city":"PORTLAND","state":"ME","zip":"04103","dob":"1957-06-19","age":"","mstatus":"","insh":"10000096047","cliId":"","pno":"2073470839","cno":"","email":"jmqb15@hotmail.com","ename":"","eno":"","pphy":"CONNOLLY, PATRICK J","ppno":"2078282402","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"51 ALLISON AVE","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":"2078282425","pcpnpi":"1982655098","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9XY4Y49UJ95","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":["N200","N2889","Z8616","R918","R059","R062","E1122","I129","Z0101","Z23","M65331","E119","H6121","H903","H9313","R040","E785","R109","K760","N12","R300","N390","T7840XA","Z87891","Z1231"],"date":["2024-06-18","2023-05-08","2023-06-17","2023-06-17","2023-06-17","2023-06-17","2023-06-17","2023-06-17","2023-07-06","2024-02-06","2023-10-25","2024-02-23","2023-12-15","2024-03-04","2024-02-01","2024-02-01","2024-02-23","2024-02-28","2024-02-28","2024-02-28","2024-04-19","2024-03-23","2024-03-23","2024-03-23","2024-06-03"],"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":[["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Mupirocin 2 % Ointment Teva","","","Select","Select",""],["","","Etodolac","500 MG","","Select","Select",""],["","","Potassium Citrate","15 MEQ","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Cyclobenzaprine","10 MG","","Select","Select",""],["","","Onetouch Ultra 2","","","Select","Select",""],["","","Solifenacin","10 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Flovent Hfa","","","Select","Select",""],["","","Zolpidem","5 MG","","Select","Select",""],["","","Onetouch Ultra","","","Select","Select",""],["","","Trulicity","","","Select","Select",""],["","","Meclizine","25 MG","","Select","Select",""],["","","Simvastatin","40 MG","","Select","Select",""],["","","Bupropion Hcl","150 MG","","Select","Select",""],["","","Cefpodoxime","200 MG","","Select","Select",""],["","","Lorazepam","1 MG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Epinephrine","0.3 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Donepezil","10 MG","","Select","Select",""],["","","Ozempic","","","Select","Select",""],["","","Dicyclomine","20 MG","","Select","Select",""],["","","Onetouch Ultrasoft 2","","","Select","Select",""],["","","Victoza Pen","","","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":""}]}]}