{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dianne M Edgecomb","gend":1,"currentgend":"","add":"134 BLAKE RD","city":"LIMESTONE","state":"ME","zip":"04750","dob":"1948-12-08","age":"","mstatus":"","insh":"10000111077","cliId":"","pno":"2073254656","cno":"","email":"declined@03212024.com","ename":"","eno":"","pphy":"SWANBERG, CALEB","ppno":"","pcpadd":"Pines Health Services,74 Access Highway","pcpcity":"Caribou","pcpstate":"ME","pcpzip":"04736","pcpcounty":"","pcpid":"","pcpname":"PINES CARIBOU HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 512","madd2":"","madd3":"","mcity":"LIMESTONE","mstate":"ME","mzip":"04750","pcpfaxno":"2074926260","pcpnpi":"1013396548","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6Q95W44MR71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","G912","Z982","Z1231","N763","M23311","L603","R55","R519","I10","Z79899","R6889","J358","L570","D225","L814","L821","L905","M109"],"date":["2024-06-06","2024-05-06","2024-05-06","2024-03-25","2024-03-14","2024-06-25","2024-05-01","2024-04-17","2024-05-06","2024-05-06","2024-05-06","2024-05-06","2024-05-28","2024-06-04","2024-06-04","2024-06-04","2024-06-04","2024-06-04","2024-06-06"],"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":[["","","Tacrolimus 0.1 % Ointment Padagis","","","Select","Select",""],["","","Levofloxacin","250 MG","","Select","Select",""],["","","Tobradex","","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Embecta Nano 2Nd Gen (Ref 320550)","","","Select","Select",""],["","","Colchicine","0.6 MG","","Select","Select",""],["","","Clotrim\/Betameth Diprop 1\/0.05 % Cream Fou","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Butal\/Acetaminophen\/Caffeine (Exempt) 50\/3","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Teva","","","Select","Select",""],["","","Lansoprazole","15 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Freestyle","","","Select","Select",""],["","","Sucralfate","1 GM","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Bd Ultra-Fine Micro","","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Lantus Solostar","","","Select","Select",""],["","","Allopurinol","100 MG","","Select","Select",""],["","","Freestyle Lite","","","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":""}]}]}