{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joan L Champagne","gend":1,"currentgend":"","add":"72 AQUAMARINE CT","city":"Auburn","state":"ME","zip":"04210","dob":"1943-01-25","age":"","mstatus":"","insh":"00008137000","cliId":"","pno":2077848471,"cno":"","email":"JRCHAMP66@GMAIL.COM","ename":"","eno":"","pphy":"ROSS, PAMELA E","ppno":2077955700,"pcpadd":"Central Maine Internal Medicine,12 High St Ste 400","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2077848471,"add2":"","add3":"","madd1":"72 AQUAMARINE CT","madd2":"","madd3":"","mcity":"Auburn","mstate":"ME","mzip":"04210","pcpfaxno":2077955727,"pcpnpi":1144200833,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1YR4EW9EE74","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","I429","R351","I510","Z0000","N3941","N3281","R3581","M65331","I10","M8580","I509","E119","Z7901","N390","H353131","H35373","L820","L298","L538","L814","D225","L821","Z872","R350","R3915","N393","Z780","N644","N630","Z1231","M8589","N3944","I340","Z853","R921","I361","H3562","I2510","Z1211","E785","E039","E118","R208","R7303","Z09"],"date":["2025-07-01","2025-07-01","2023-06-15","2025-07-01","2023-05-01","2023-11-27","2024-01-08","2024-01-08","2023-12-22","2024-11-04","2023-05-01","2023-11-02","2025-09-11","2023-07-17","2024-07-22","2025-02-18","2025-02-18","2024-07-23","2024-07-23","2024-07-23","2025-07-23","2025-07-23","2025-07-23","2025-07-23","2023-06-15","2023-06-15","2023-06-15","2024-12-23","2022-12-06","2022-12-06","2024-12-23","2024-12-23","2024-07-22","2025-08-21","2024-11-04","2022-12-06","2025-08-21","2024-08-12","2025-07-01","2023-07-01","2024-11-04","2024-11-04","2024-09-30","2024-07-23","2023-11-02","2022-08-17"],"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",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","PILOCARPINE HCL","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","TROSPIUM CHLORIDE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","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":""}]}]}