{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kate Borduas","gend":1,"currentgend":"","add":"11 EVERGREEN FARMS RD","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1951-10-09","age":"","mstatus":"","insh":"10000110357","cliId":"","pno":"2076532496","cno":"2076538451","email":"kateborduas@gmail.com","ename":"","eno":"","pphy":"HOFFMAN, SARA M","ppno":"2077998596","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 EVERGREEN FARMS RD","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":"2078287850","pcpnpi":"1073586491","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1UT3DV4KC03","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":["S93402A","S9002XA","D0439","L219","Z760","D492","Z87440","N281","K760","K449","N390","S99912A","S93432A","Z0101","L570","M5450","N3000","M5136","M47816","M79605","S39012A","Z13820","Z1231","Z780"],"date":["2024-01-19","2024-01-19","2024-01-17","2024-01-17","2024-01-17","2024-01-17","2024-02-09","2024-02-09","2024-02-09","2024-02-09","2024-06-01","2024-03-18","2024-03-18","2024-03-19","2024-05-01","2024-05-21","2024-05-18","2024-05-21","2024-05-21","2024-07-12","2024-07-12","2024-06-27","2024-06-27","2024-06-27"],"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",""],["","","Citalopram","10 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Taro","","","Select","Select",""],["","","Fenofibrate","160 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Cefpodoxime","200 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Amiodarone","200 MG","","Select","Select",""],["","","Fosfomycin","3 GM","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Gabapentin","100 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Teva","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Losartan","25 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Metoprolol Succ","25 MG","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Greenstone","","","Select","Select",""],["","","Pravastatin","40 MG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","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":""}]}]}