{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carolyn A Jordan","gend":1,"currentgend":"","add":"412 SPRINGY POND ROAD","city":"CLIFTON","state":"ME","zip":"04428","dob":"1948-03-17","age":"","mstatus":"","insh":"10000101824","cliId":"","pno":"2079441808","cno":"","email":"flynanny60@gmail.com","ename":"","eno":"","pphy":"RINFRET, RAQUELLE","ppno":"","pcpadd":"900 BROADWAY BLDG 5,","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44011900","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"412 SPRINGY POND ROAD","madd2":"","madd3":"","mcity":"CLIFTON","mstate":"ME","mzip":"04428","pcpfaxno":"","pcpnpi":"1184366239","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1Y50K23JG09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J309","R6889","K219","K2270","K52831","R197","Z0000","Z1231","Z23","E7800","Z0101","H40013","Z86010","Z8719","D509","D225","L821","L814","Z7189","M6289","H2513","H2511","T148XXA","L089","H2512"],"date":["2023-06-13","2023-04-27","2023-10-13","2023-12-19","2023-07-19","2023-07-19","2023-10-13","2024-02-22","2023-10-13","2024-04-02","2023-11-15","2023-11-15","2023-12-11","2023-12-11","2023-12-11","2024-02-29","2024-02-29","2024-02-29","2024-02-29","2024-04-16","2024-05-14","2024-06-03","2024-06-20","2024-06-20","2024-06-24"],"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":[["","","Triamcinolone Acet 0.1 % Cream Taro","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Pacific","","","Select","Select",""],["","","Sertraline","25 MG","","Select","Select",""],["","","Rosuvastatin","5 MG","","Select","Select",""],["","","Paxlovid","300\/100 MG","","Select","Select",""],["","","Creon","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Levothyroxine","112 MCG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 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":""}]}]}