{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy A Thibodeau","gend":1,"currentgend":"","add":"877 MAIN ST APT E4","city":"CARIBOU","state":"ME","zip":"04736","dob":"1946-04-30","age":"","mstatus":"","insh":"00008139500","cliId":"","pno":2074982525,"cno":"","email":"gthibodeau3@maine.rr.com","ename":"","eno":"","pphy":"SWANBERG, CALEB","ppno":"","pcpadd":"Pines Health Services,74 Access Highway","pcpcity":"Caribou","pcpstate":"ME","pcpzip":"04736","pcpcounty":"","pcpid":"","pcpname":"PINES CARIBOU HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2074982525,"add2":"","add3":"","madd1":"877 MAIN ST APT E4","madd2":"","madd3":"","mcity":"CARIBOU","mstate":"ME","mzip":"04736","pcpfaxno":2074926260,"pcpnpi":1013396548,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9F36M84JG76","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":["M7130","M1612","Z0101","Z961","I083","I2720","M5416","S8251XA","R600","R7989","I480","R233","M461","S9031XA","X58XXXA","R6889","R000","Z1231","Z0000","I38","I340","I4811","I352","I10","I4891","I2510","Z953","E538","R1110","E871","I350","I952","I110","I5030","R001","I119","M25552","R7881","R195","K219","Z860100","M5450","I491","I454","M47816","M8589","M810","I700","Z01810","K319","D120","D123","Z471","Z96642","I4820","S8253XA","D508","M19042","I5033","Z79899","Z5321","M7989","R002","W228XXA","I081","D649","T148XXA","A4181","F419","E785","M47817","M961","K2950","M7918","Z23","Z1211","Z01812","K5732","Z86010","Z1212","M9905"],"date":["2025-09-04","2024-03-12","2025-01-07","2025-01-07","2024-05-14","2024-05-14","2024-12-19","2025-09-23","2024-02-14","2024-02-14","2025-09-16","2023-11-13","2023-11-09","2025-09-17","2025-09-17","2023-12-15","2024-05-14","2024-12-17","2025-08-15","2025-10-20","2025-10-20","2025-04-28","2024-07-12","2025-09-22","2025-09-22","2025-09-22","2025-11-12","2025-01-23","2023-10-03","2023-11-06","2024-10-31","2025-05-04","2025-08-11","2025-08-11","2025-04-23","2025-05-30","2023-09-07","2025-10-30","2025-06-05","2025-06-05","2025-06-05","2023-05-01","2024-10-14","2024-10-14","2023-01-23","2025-11-05","2025-11-05","2024-07-30","2023-12-26","2025-06-20","2025-06-20","2025-06-20","2024-03-28","2024-03-28","2025-05-27","2025-09-23","2025-10-07","2024-11-27","2024-09-12","2025-01-24","2025-03-27","2025-09-18","2024-09-11","2025-09-23","2023-02-11","2024-01-15","2023-08-25","2025-10-15","2023-01-31","2024-11-14","2023-02-24","2023-02-24","2025-06-20","2023-04-11","2022-10-27","2022-10-07","2022-10-05","2022-10-07","2022-10-07","2022-09-21","2022-08-16"],"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":[["","","METRONIDAZOLE","","","Select","Select",""],["","","MULTAQ","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","IRBESARTAN","","","Select","Select",""],["","","TOLTERODINE TARTRATE ER","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","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":""}]}]}