{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joan E Sandidge","gend":1,"currentgend":"","add":"9 COUNTRY CLOSET LN","city":"Wayne","state":"ME","zip":"04284","dob":"1944-02-23","age":"","mstatus":"","insh":"00007816200","cliId":"","pno":2073035521,"cno":"","email":"jsandid9@gmail.com","ename":"","eno":"","pphy":"COTA, LINDA W","ppno":2078976601,"pcpadd":"21 MAIN ST,","pcpcity":"LIVERMORE FALLS","pcpstate":"ME","pcpzip":"42541219","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2076853638,"add2":"","add3":"","madd1":"9 COUNTRY CLOSET LN","madd2":"","madd3":"","mcity":"Wayne","mstate":"ME","mzip":"04284","pcpfaxno":2078974339,"pcpnpi":1780181818,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8VK3WA3KM96","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U071","H2511","G4700","N1832","I2510","I429","I340","I351","E785","E039","Z713","I25110","E119","Z0000","B379","R809","I10","H25811","H25812","R918","S20364A","S30861A","W57XXXA","H2512","S161XXA","I517","N184","Z0100","K219","I25119","K2950","K317","N3281","N393","R3911","I509","Q248","Z1231","J811","R079","N2581","D649","H6123","Z09","E1122","N390","R410","R911","H2513","D3131","R221","M5430","S1086XA","S2096XA","H5231","R590","I214","E1165","K146","R000","I200","I5030","N189","Z1211","Z1212","I6523","K222","K449","I447","I25118","I25708","Z951","R0989","I2582","Z23","I129","I249","R9431","R3915","R350","I3489","U099","R059","R5383","I959","Z20822","I083","E7800","I493","R6889","H10413"],"date":["2024-05-01","2023-07-12","2024-11-06","2025-03-18","2025-09-30","2023-03-28","2023-09-22","2023-09-22","2025-05-09","2025-05-09","2024-08-20","2025-05-17","2025-06-06","2025-09-02","2024-01-10","2024-09-20","2025-06-20","2023-07-12","2023-07-12","2023-09-14","2025-06-23","2025-06-23","2025-06-23","2023-07-26","2025-11-07","2022-11-30","2025-06-12","2025-09-18","2025-04-11","2025-06-27","2024-12-12","2023-02-03","2025-09-26","2025-09-26","2025-09-26","2023-08-03","2023-09-14","2025-09-12","2023-03-14","2025-05-17","2025-04-03","2025-05-17","2025-09-09","2023-01-30","2025-09-09","2024-09-20","2024-01-10","2023-09-21","2023-02-16","2023-02-16","2025-01-02","2023-01-05","2024-06-08","2024-06-08","2025-07-17","2025-01-02","2023-03-16","2023-03-16","2023-07-03","2023-03-14","2023-03-14","2025-05-17","2022-11-28","2023-01-04","2023-01-04","2024-04-30","2025-01-03","2023-02-03","2025-05-19","2025-05-20","2025-05-20","2025-05-20","2023-09-22","2023-03-15","2024-10-03","2023-03-15","2023-03-14","2023-03-14","2023-05-09","2023-05-09","2023-08-03","2024-05-09","2024-05-09","2024-05-09","2025-04-03","2022-11-24","2022-11-25","2022-10-04","2022-10-21","2022-09-08","2022-08-23"],"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":[["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","RANOLAZINE ER","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TROSPIUM CHLORIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","PIOGLITAZONE HCL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","PAXLOVID","","","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":{"indx":[],"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":""}]}]}