{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Virginia M Starbird","gend":1,"currentgend":"","add":"273 LISBON RD APT 2","city":"Lisbon","state":"ME","zip":"04252","dob":"1938-12-06","age":"","mstatus":"","insh":"00008138400","cliId":"","pno":2073300136,"cno":"","email":"ginstar38@aol.com","ename":"","eno":"","pphy":"WYMAN, PEGGY","ppno":2075243501,"pcpadd":"180 CHURCH HILL RD STE 1,","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 ROY ST","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":2075242093,"pcpnpi":1073592283,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6XJ5MC7EK64","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25562","K5900","R911","G5601","R739","Z0000","Z471","Z96642","M25552","M7632","M1712","R109","M1612","Z96641","Z09","Z872","Z08","Z85828","L570","H35363","L989","D485","M25561","M8580","H109","D044","M8588","M25551","M533","M5450","M25511","M25611","G8929","H353131","M19011","H2512","Z1231","R6889","E785","M75100","H259","M1711","J441","Z87891","R059","R0989","I10","K219","H26493","H353130","H2513","D229","M25512","R197","M5136","H2511","H04123","M461","A419","M19012","Z01818","E559","M159","R079","R791","M7631","M47818","M170","M4698","R509","M7521","R202","M10272","M19041","Z23","R200","M1120","M1811","M79641","M79672","M19072","N390","N3000","K8050"],"date":["2023-09-25","2025-07-03","2025-07-01","2023-06-27","2025-07-21","2025-07-21","2025-08-13","2025-08-13","2023-11-06","2023-11-06","2023-11-06","2025-07-01","2025-06-26","2023-09-18","2025-01-14","2025-01-14","2025-01-14","2025-01-14","2024-06-07","2025-08-27","2024-04-12","2024-06-07","2023-12-26","2024-07-22","2024-05-05","2024-08-29","2023-04-27","2023-09-18","2024-06-11","2024-06-11","2023-09-05","2023-09-05","2025-11-18","2025-02-20","2023-12-05","2023-02-15","2025-07-26","2023-03-16","2025-07-14","2023-01-18","2023-02-15","2024-06-24","2024-04-21","2024-04-21","2024-04-21","2024-04-21","2024-07-08","2025-05-15","2024-06-27","2022-12-22","2022-12-22","2024-01-08","2025-11-18","2023-04-10","2023-08-02","2023-02-01","2023-04-20","2023-08-17","2025-07-01","2025-11-18","2025-06-23","2025-06-17","2024-07-22","2025-07-01","2025-07-01","2023-09-01","2023-09-01","2024-06-24","2023-08-09","2025-07-01","2023-12-05","2022-11-15","2022-10-24","2022-11-15","2022-10-24","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-09-18","2022-09-18","2022-09-01","2022-09-01","2022-08-22"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","SIMVASTATIN","","","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":""}]}]}