{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah A Simard","gend":1,"currentgend":"","add":"247 GRANGE AVE","city":"MINOT","state":"ME","zip":"04258","dob":"1958-02-28","age":"","mstatus":"","insh":"10000104884","cliId":"","pno":"2075146459","cno":"","email":"DECLINED@01172026.COM","ename":"","eno":"","pphy":"ALLEN, JOSHUA","ppno":"","pcpadd":"364 MAINE ST,","pcpcity":"POLAND","pcpstate":"ME","pcpzip":"42745109","pcpcounty":"","pcpid":"","pcpname":"POLAND COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"247 GRANGE AVE","madd2":"","madd3":"","mcity":"MINOT","mstate":"ME","mzip":"04258","pcpfaxno":"2079985756","pcpnpi":"1124686142","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9PK3J05EW93","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","Z6828","E039","E785","R7989","L659","R1011","L989","Z1231","M85852","K829","G43909","F17210","Z87891","K2270","K22719","K449","M79643","R002","L853","Z9884","Z1211","K5730","K640","D122","D123","D124"],"date":["2023-05-23","2023-05-23","2023-05-23","2024-05-08","2023-05-24","2023-05-23","2024-03-12","2023-05-23","2023-07-25","2023-07-25","2023-07-25","2023-11-14","2023-08-14","2023-08-14","2024-01-30","2023-10-09","2024-05-14","2023-11-14","2023-11-14","2024-01-30","2024-01-30","2024-04-09","2024-04-09","2024-04-09","2024-04-09","2024-04-09","2024-04-09"],"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":[["","","Gavilyte-G","","","Select","Select",""],["","","Tolterodine","4 MG","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Amitriptyline","50 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Rosuvastatin","5 MG","","Select","Select",""],["","","Verapamil","40 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","Levothyroxine","100 MCG","","Select","Select",""],["","","Prednisone","5 MG","","Select","Select",""],["","","Hydrocortisone 2.5 % Cream Taro","","","Select","Select",""],["","","Amitriptyline Hcl","","","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":""}]}]}