{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Suzanne R Leibowitz","gend":1,"currentgend":"","add":"70 BEANS CORNER RD","city":"PITTSFIELD","state":"ME","zip":"04967","dob":"1943-06-17","age":"","mstatus":"","insh":"00000007502","cliId":"","pno":2074875446,"cno":"","email":"SUEISRETIRED@TDS.NET","ename":"","eno":"","pphy":"PROKOP, OTO","ppno":2074740905,"pcpadd":"REDINGTON MED PRIMARY CA,46 FAIRVIEW AVE STE 111","pcpcity":"SKOWHEGAN","pcpstate":"ME","pcpzip":"04976","pcpcounty":"","pcpid":"","pcpname":"REDINGTON MEDICAL PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2074875446,"add2":"","add3":"","madd1":"70 BEANS CORNER RD","madd2":"","madd3":"","mcity":"PITTSFIELD","mstate":"ME","mzip":"04967","pcpfaxno":2074746930,"pcpnpi":1083631014,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3K25CX4CG56","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":["Z1231","N898","Z853","H3554","H35373","D225","L821","L814","L2089","H8102","L239","H527","H8109","M810","D369","Z6379","H906","Z7189","H903","K529","D509","K2960","F419","D649","H6123","C50412","H9192","N1830","Z79899","Z0000","Z23","K5080","K219","D122","K621","R5383","H40013","I129","C50912","C50919","Z1211","Z1212","Z13820","Z08","E7800","H90A22","H90A31","M5414","K760","K5900","I700","H26492"],"date":["2025-01-06","2025-03-19","2024-09-03","2025-09-19","2025-09-19","2024-06-10","2024-06-10","2024-06-10","2024-06-10","2025-05-20","2023-08-24","2025-09-19","2025-09-23","2025-08-20","2023-08-10","2025-10-28","2024-08-29","2022-12-21","2024-05-30","2023-04-06","2023-04-06","2023-04-06","2025-08-20","2024-10-30","2025-03-27","2024-03-13","2025-09-23","2023-10-05","2025-08-20","2024-11-01","2024-10-14","2025-05-02","2025-05-02","2025-05-02","2025-05-02","2024-01-04","2023-07-25","2024-05-13","2023-03-22","2025-03-12","2025-05-02","2025-05-02","2025-06-13","2024-09-11","2022-10-06","2022-09-22","2022-09-22","2022-07-08","2022-07-29","2022-07-29","2022-07-29","2022-06-15"],"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":[["","","MESALAMINE","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","TAMOXIFEN CITRATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","MESALAMINE DR","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}