{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Edward B Smith","gend":0,"currentgend":"","add":"41 SAND BEACH RD","city":"STANDISH","state":"ME","zip":"04084","dob":"1957-01-27","age":"","mstatus":"","insh":"10000106676","cliId":"","pno":"2073108382","cno":"","email":"edbsmith57@gmail.com","ename":"","eno":"","pphy":"ROVNER, ROBERT B","ppno":"2076753121","pcpadd":"Steep Falls Family Practice,PO Box 39","pcpcity":"Steep Falls","pcpstate":"ME","pcpzip":"04085","pcpcounty":"","pcpid":"","pcpname":"STEEP FALLS FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"41 SAND BEACH RD","madd2":"","madd3":"","mcity":"STANDISH","mstate":"ME","mzip":"04084","pcpfaxno":"2076753396","pcpnpi":"1902912371","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2AH2RP5HT99","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":["F331","F902","I10","M25811","N390","R0781","J189","K2100","F17210","R079","J159","B349","M5416","Z01812","M5116","M5137","R911","J432","F1020"],"date":["2023-11-14","2023-09-13","2023-08-24","2023-09-26","2023-08-10","2023-12-13","2023-12-13","2023-12-13","2023-12-13","2023-12-14","2023-12-27","2024-01-06","2024-05-30","2024-03-18","2024-04-09","2024-04-09","2024-04-11","2024-04-11","2024-02-08"],"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":[["","","Myrbetriq","","","Select","Select",""],["","","Dextroamphetamine-Amphetamine","","","Select","Select",""],["","","Dextroamphet\/Amphet","30 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Sodium Fluoride 5000 Ppm (Spearmint)","","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Mirabegron","25 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Solifenacin","10 MG","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","Oxybutynin","5 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":""}]}]}