{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Irene R Duplissis","gend":1,"currentgend":"","add":"70 BAXTER AVE","city":"AUBURN","state":"ME","zip":"04210","dob":"1939-06-13","age":"","mstatus":"","insh":"00008269800","cliId":"","pno":2072402907,"cno":"","email":"idupliss@yahoo.com","ename":"","eno":"","pphy":"BUTTERFIELD, TAYLOR C","ppno":2077847388,"pcpadd":"Family Health Care Associates,190 Stetson Rd","pcpcity":"Auburn","pcpstate":"ME","pcpzip":"04210","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2077950805,"add2":"","add3":"","madd1":"70 BAXTER AVE","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":2077952043,"pcpnpi":1427288810,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5FP6FC2UH75","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":["J449","I2510","J45909","R202","L723","R053","I10","E785","K219","B370","R490","M25552","G8929","K760","H35373","E6601","N898","J441","H35363","L820","Z789","L538","L814","D2239","L821","D2262","D485","R0600","R059","J9811","R0602","I361","R918","R600","Z0000","I2720","H353132","Z09","R7989","M722","D225","J849","N200","Z23","R911","M79662","Z1231","Z7902"],"date":["2025-11-07","2025-10-22","2023-07-17","2025-11-12","2025-11-12","2024-12-04","2024-03-26","2024-03-26","2025-10-22","2025-03-28","2024-07-01","2023-03-27","2024-10-07","2024-03-07","2025-09-24","2024-08-26","2023-04-03","2025-02-28","2024-02-08","2023-02-06","2023-02-06","2023-02-06","2025-02-10","2025-02-10","2025-02-10","2025-02-10","2023-02-06","2023-07-13","2023-10-11","2023-03-13","2023-03-13","2023-09-20","2023-07-13","2023-07-17","2025-10-22","2023-09-20","2025-09-24","2024-03-26","2024-01-10","2025-03-13","2023-02-06","2023-07-13","2024-03-07","2022-10-06","2022-09-14","2022-09-06","2022-09-09","2022-08-24"],"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":[["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","TRIMETHOPRIM","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","BREYNA","","","Select","Select",""],["","","PROCTO-MED HC","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","SPIRIVA HANDIHALER","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","PROCTOZONE-HC","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","TOPROL XL","","","Select","Select",""],["","","FUROSEMIDE","","","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":""}]}]}