{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia A Maines","gend":1,"currentgend":"","add":"612 MEADOW ROAD","city":"Casco","state":"ME","zip":"04015","dob":"1942-05-28","age":"","mstatus":"","insh":"00000007481","cliId":"","pno":2076719000,"cno":"","email":"patmaines42@gmail.com","ename":"","eno":"","pphy":"CAMPBELL, CORINNA M","ppno":2074008600,"pcpadd":"St Marys Regional Medical Center Pb,791 Turner St","pcpcity":"Auburn","pcpstate":"ME","pcpzip":"04210","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2076719000,"add2":"","add3":"","madd1":"PO BOX 292","madd2":"","madd3":"","mcity":"Casco","mstate":"ME","mzip":"04015","pcpfaxno":2077836660,"pcpnpi":1043720667,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3NK4H94TJ93","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D45","K8020","N281","K7689","R1012","M25511","R6889","R0789","R200","I4891","I480","I10","E785","E6601","K760","Z7901","Z1231","Z79899","Z0100","E876","Z0101","Z0001","Z13820","E669","Z87891","M2550","M19011","M79621","I4819","D471","R059","R009","E871","Z0000","H35372"],"date":["2025-10-06","2024-01-19","2024-01-19","2024-01-19","2024-01-19","2023-06-21","2023-04-27","2023-01-20","2023-01-20","2025-09-23","2023-09-19","2025-09-23","2025-10-06","2025-09-23","2024-01-19","2025-01-14","2024-10-18","2025-01-14","2024-04-29","2023-03-08","2025-05-15","2025-10-13","2025-04-24","2023-07-06","2025-07-14","2023-11-07","2023-03-01","2023-03-01","2023-11-10","2023-06-22","2022-10-14","2022-10-14","2022-09-21","2022-09-02","2022-06-29"],"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":[["","","HYDROXYUREA","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":""}]}]}