{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rita L Duguay","gend":1,"currentgend":"","add":"104 MAIN ST","city":"Livermore Falls","state":"ME","zip":"04254","dob":"1938-05-16","age":"","mstatus":"","insh":"00007728900","cliId":"","pno":2078974677,"cno":"","email":"declined@02282025.com","ename":"","eno":"","pphy":"DAVIS, MARY E","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2078974677,"add2":"","add3":"","madd1":"104 MAIN ST","madd2":"","madd3":"","mcity":"Livermore Falls","mstate":"ME","mzip":"04254","pcpfaxno":2077955727,"pcpnpi":1215917919,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1GT6YK0UT66","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","N1832","I130","I5023","I4710","I429","I5020","I509","Z5181","I10","D649","N189","Z79899","M170","H353221","D509","Q141","H353111","N6489","R92321","Z09","R0600","Z1231","Z9189","R059","H353132","D3121","R0602","I4819","I5021","I358","I340","R21","Z0000","E7800","I499","I872","S66912A","I129","M79642","H43813","I480","S6992XA","I4510","H353131","I3481","I517","H31103","R6889"],"date":["2025-02-20","2024-12-02","2024-07-18","2024-07-18","2024-07-18","2024-07-18","2023-06-21","2024-07-31","2024-07-22","2025-04-17","2023-07-25","2025-04-17","2024-12-05","2025-03-28","2025-11-18","2024-10-30","2024-08-12","2025-11-18","2025-05-21","2025-05-21","2024-10-28","2024-07-17","2025-04-29","2025-10-28","2024-07-20","2024-08-19","2024-02-26","2024-07-17","2025-07-25","2024-07-21","2024-07-18","2024-07-18","2024-07-03","2023-03-16","2024-01-22","2025-10-28","2023-03-16","2025-08-06","2025-09-03","2025-09-03","2024-08-19","2025-04-17","2025-09-03","2024-07-21","2023-12-22","2024-07-18","2023-06-21","2025-08-19","2022-10-31"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","TIADYLT ER","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DILT-XR","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}