{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anna P Bilodeau","gend":1,"currentgend":"","add":"154 THISTLE STREET","city":"NEWRY","state":"ME","zip":"04261","dob":"1945-02-15","age":"","mstatus":"","insh":"00008389900","cliId":"","pno":2075332315,"cno":"","email":"","ename":"","eno":"","pphy":"GALLANT, KIMBERLY R","ppno":6037522040,"pcpadd":"133 PLEASANT ST,","pcpcity":"BERLIN","pcpstate":"NH","pcpzip":"35702006","pcpcounty":"","pcpid":"","pcpname":"COOS COUNTY FAMILY HEALTH SERVICES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"154 THISTLE STREET","madd2":"","madd3":"","mcity":"NEWRY","mstate":"ME","mzip":"04261","pcpfaxno":6037527797,"pcpnpi":1730166174,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7KK5QN6AM56","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50111","N83202","E278","R3129","I700","C55","C541","Z1231","C549","Z0000","F17201","R413","N950","R918","R300","R319","E039","E785","K219","J449","Z08","Z8542","Z923","Z98890","G629","Z87891","Z853","Z9851","M8589","C50919","Z79899","Z170","Z978","E041","R220","R221","N83292","Z1211","N888","R9389","Z510","C539","J479","D369","G5601","H43811","H2513","N3289","D123","U071","G5602"],"date":["2025-03-25","2023-04-28","2024-06-25","2023-04-28","2023-12-28","2025-08-26","2024-10-17","2025-09-25","2024-04-25","2025-05-29","2023-12-28","2023-12-22","2023-11-21","2024-06-25","2023-07-21","2023-04-28","2025-07-17","2024-01-22","2024-01-22","2024-01-22","2024-10-17","2024-10-17","2024-10-17","2024-03-01","2025-01-09","2024-01-22","2024-01-22","2024-01-22","2023-09-25","2023-09-25","2025-09-25","2025-03-25","2024-02-20","2023-09-06","2023-09-06","2023-09-06","2023-06-14","2023-04-04","2023-06-14","2023-06-14","2024-05-24","2023-12-28","2023-12-28","2023-12-28","2023-01-04","2025-03-13","2025-01-13","2025-01-09","2023-04-04","2022-10-05","2022-06-28"],"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":[["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","EXEMESTANE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}