{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary Doran","gend":1,"currentgend":"","add":"25 GROVERS XING","city":"FREEPORT","state":"ME","zip":"04032","dob":"1952-02-27","age":"","mstatus":"","insh":"10000101279","cliId":"","pno":"2078650112","cno":"","email":"Maryjd2005@gmail.com","ename":"","eno":"","pphy":"PIERCE, DANIEL C","ppno":"2078469013","pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2078389793","add2":"","add3":"","madd1":"PO BOX 244","madd2":"","madd3":"","mcity":"South Freeport","mstate":"ME","mzip":"04078","pcpfaxno":"2078741483","pcpnpi":"1861451080","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5A25AA7DG65","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23","I480","E785","Z0001","L84","E039","H16223","H0288A","H0288B","L719","E7800","I493","L578","L814","Z85828","D1801","D3132","Z0100","H00021","H0100A","H0100B","H02052","M79671","M19071","M2011","M7731","M8580","M722","Z1231"],"date":["2023-11-02","2023-09-28","2023-07-13","2023-07-20","2023-07-20","2023-08-31","2023-09-12","2024-03-13","2024-03-13","2023-09-12","2023-09-28","2023-09-28","2023-10-17","2023-10-17","2023-10-17","2023-10-17","2023-10-19","2023-10-19","2023-12-20","2024-03-13","2024-03-13","2024-03-13","2024-05-21","2024-05-06","2024-05-06","2024-05-06","2024-05-15","2024-05-21","2024-07-05"],"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":[["","","Clobetasol 0.05 % Top Sol Taro","","","Select","Select",""],["","","Levothyroxine","50 MCG","","Select","Select",""],["","","Pravastatin","10 MG","","Select","Select",""],["","","Rosuvastatin","5 MG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Metoprolol Succ","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":""}]}]}