{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Frances M Furbush","gend":1,"currentgend":"","add":"2 WENTWORTH CT","city":"OAKLAND","state":"ME","zip":"04963","dob":"1937-02-14","age":"","mstatus":"","insh":"00000007449","cliId":"","pno":2074653502,"cno":"","email":"","ename":"","eno":"","pphy":"PHELPS, JULIE J","ppno":"","pcpadd":"Waterville Family Practice,31 Front St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"WATERVILLE FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2 WENTWORTH CT","madd2":"","madd3":"","mcity":"OAKLAND","mstate":"ME","mzip":"04963","pcpfaxno":2078731186,"pcpnpi":1679562979,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6QW4AE5RM04","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M85851","M85852","S32010S","M818","Z01812","R441","E119","J189","J90","D71","N281","R053","M25512","R109","S2241XA","S92352A","Z7982","I10","F330","E039","S060X0D","M79605","H532","R6883","M79672","M25572","M7989","R7989","M19012","K2270","F419","Z4789","R059","R918","R937","H4922","R4182","H35362","Z23","S92812A","W19XXXA","Z789","R296","R262","R5381","I629","E538","L570","S32010D","I70219","S32030A","M8000XA","M8589","Z780","S2241XD","R112","K2100","I2510","M810","E785","R079","J310","H1132","S4992XA","R9389","R627","R519","G319","S06320A","R5383","Z20828","M25532","M19022","M25422","I619","S0990XA","Z9181","S52122D","X58XXXD","L820","G9389","M19072","Z139","Z0000","Z1331","S52122A","S2249XA","K449","S199XXA","M4310","M4802","M47812","M808AXD","S0003XA","R220","T7840XA","Z1389","S92902D","S32030D","E871","E7801","H5005","C799","M47816","M47817","M4856XA","R739","M5450","M160","M5459"],"date":["2023-01-12","2023-01-12","2023-07-24","2024-12-09","2023-10-16","2024-03-28","2025-09-15","2023-09-26","2023-10-16","2023-10-16","2023-10-16","2024-07-08","2025-02-20","2023-12-01","2025-01-13","2025-01-13","2025-01-12","2025-05-12","2025-05-12","2025-05-12","2024-03-28","2023-05-16","2024-05-28","2023-09-26","2023-05-15","2023-05-15","2023-05-16","2023-05-16","2025-02-20","2025-02-01","2025-02-01","2025-02-27","2023-09-26","2025-01-12","2023-09-21","2023-11-30","2024-02-20","2024-01-10","2025-09-15","2025-01-13","2025-01-13","2025-01-13","2023-12-20","2023-12-20","2023-12-20","2023-12-20","2023-11-28","2025-03-26","2023-12-05","2024-01-25","2022-12-09","2022-12-09","2023-12-27","2023-12-27","2025-02-01","2025-01-18","2024-05-09","2025-01-27","2025-01-27","2025-01-27","2023-12-01","2023-06-27","2023-06-27","2025-02-20","2024-01-02","2023-12-03","2023-12-03","2025-01-12","2023-12-01","2023-09-21","2023-09-21","2023-12-20","2023-12-20","2023-12-20","2023-12-03","2023-12-03","2023-12-03","2023-12-20","2023-12-20","2025-03-26","2023-11-30","2025-01-12","2024-12-16","2024-12-16","2024-12-16","2023-12-09","2025-01-12","2025-01-12","2025-01-12","2025-01-12","2025-01-12","2025-01-12","2025-02-27","2025-01-12","2025-01-12","2023-09-14","2024-12-16","2025-02-20","2022-12-09","2023-10-02","2022-11-28","2024-05-28","2022-11-18","2022-11-18","2022-11-18","2022-11-18","2022-11-17","2022-11-07","2022-11-07","2022-11-07"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","MELOXICAM","","","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":""}]}]}