{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elise G Thomas","gend":1,"currentgend":"","add":"20 FALCON DR","city":"CUMBERLAND FORESIDE","state":"ME","zip":"04110","dob":"1952-12-25","age":"","mstatus":"","insh":"10000106211","cliId":"","pno":"8604247116","cno":"","email":"ELISE.G.THOMAS@GMAIL.COM","ename":"","eno":"","pphy":"BUCHBERGER, GLENN K","ppno":"2077745816","pcpadd":"InterMed,84 Marginal Way Ste 700","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 FALCON DR","madd2":"","madd3":"","mcity":"CUMBERLAND FORESIDE","mstate":"ME","mzip":"04110","pcpfaxno":"2075238597","pcpnpi":"1598054702","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2T26C56EH87","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F419","I428","I351","I447","E785","R413","G40219","W19XXXD","R2689","Z23","R61","Q231","R9089","G3184","Z0000","F418","K7689","K3189","J984","R8290","Z1231","R92331","R922","Z0100","K1329","R930","M810","R9431","I7121","G40119","N289","Z008","Z0001"],"date":["2023-07-19","2023-09-08","2023-09-08","2023-09-08","2023-09-08","2023-12-19","2024-03-05","2023-10-05","2023-10-05","2024-04-10","2023-10-25","2023-10-04","2023-10-05","2023-10-05","2023-10-04","2024-03-11","2023-10-25","2023-10-25","2023-10-25","2023-11-16","2023-11-18","2023-12-04","2023-12-04","2023-12-08","2024-01-05","2024-01-09","2024-03-14","2024-03-01","2024-03-01","2024-03-04","2024-03-29","2024-03-20","2024-04-10"],"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",""],["","","Escitalopram","10 MG","","Select","Select",""],["","","Losartan","25 MG","","Select","Select",""],["","","Carvedilol","3.125 MG","","Select","Select",""],["","","Rosuvastatin","5 MG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Levetiracetam","500 MG","","Select","Select",""],["","","Arexvy","","","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":""}]}]}