{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Faye L Riendeau","gend":1,"currentgend":"","add":"3 B RAYMOND RD","city":"Topsham","state":"ME","zip":"04086","dob":"1945-03-13","age":"","mstatus":"","insh":"00008430500","cliId":"","pno":2077291200,"cno":"","email":"declined@07142023.com","ename":"","eno":"","pphy":"INGER, DAVID","ppno":"","pcpadd":"Mid Coast Medical Group Topsham Internal Medicine,1 Wellness Way Ste A","pcpcity":"Topsham","pcpstate":"ME","pcpzip":"04086","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2077291200,"add2":"","add3":"","madd1":"3 B RAYMOND RD","madd2":"","madd3":"","mcity":"Topsham","mstate":"ME","mzip":"04086","pcpfaxno":"","pcpnpi":1215941372,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6P05KE9HW85","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I739","M79602","M48062","G834","D472","L97512","N390","M549","M79674","M79675","R2242","L97522","M86072","I10","K219","R4182","F4321","Z0000","M25512","F5104","Z1231","M79604","N289","M7989","N1832","Z1329","A000","I129","R001","M79662","M7910","R9089","I6350","Z634","E1142","M5450","R296","I70209","L97529","Z0101","B351","Z89411","F330","M3500","M7061","M160","N1830","M5459","L0291","M79605","R600","M47816","D649","M25552","S51012S","W19XXXD","R32","F05","Z4789","M1811","M19041","M79641","M85841","F4323","L02612","L03032","M2042","M79672","S92352A","M79671","S91109A","S91301A","M7062","E119","M1612","S0990XA","Z5321","L03116","H26493","I442","I441","I4710","I454","R2681","R030","Z043","M48061","I70202","I7092","E785","T07XXXA","H26492","H353131","R609","S51012A","S7002XA","S5002XA","S6981XA","S6991XS","T69021A","M19012","R739","U071","Z981","L03115","R339","F32A","R6889","M25522","Z23","E782","R0609","R300","R5383","G603","Z20822","I4891","M792","M79673","R630","R519","L600","L89629","G44229"],"date":["2024-09-19","2024-10-23","2024-11-27","2024-11-27","2024-10-15","2024-11-11","2024-03-25","2024-11-26","2024-08-05","2024-08-05","2023-08-14","2024-07-08","2023-08-14","2024-12-05","2024-11-27","2024-11-27","2024-10-14","2024-12-05","2024-10-14","2024-12-05","2022-12-02","2023-07-28","2023-07-18","2023-08-22","2024-08-27","2024-01-30","2024-12-04","2024-02-08","2024-02-08","2023-04-30","2023-04-30","2024-02-16","2024-02-16","2024-07-03","2024-02-01","2024-11-26","2024-02-15","2024-02-12","2023-10-06","2023-02-27","2024-08-05","2024-02-07","2023-11-03","2023-10-25","2023-10-23","2023-10-23","2023-10-23","2023-10-23","2023-06-27","2024-07-09","2024-07-09","2024-11-07","2024-04-17","2023-10-11","2023-06-26","2023-06-26","2024-11-26","2024-02-16","2024-12-04","2023-07-25","2023-07-25","2023-07-25","2023-07-25","2023-10-30","2023-06-27","2023-08-10","2023-08-10","2024-09-03","2024-09-03","2024-02-07","2024-02-07","2024-02-07","2023-04-18","2023-04-18","2023-06-13","2023-06-13","2023-04-28","2024-07-09","2024-04-05","2025-01-17","2025-01-17","2025-01-17","2025-01-17","2023-11-03","2023-11-03","2023-06-13","2024-03-21","2024-01-23","2024-01-23","2024-07-31","2023-06-13","2024-01-17","2024-01-17","2023-10-11","2023-06-13","2023-06-13","2023-06-13","2023-07-24","2023-07-24","2024-02-14","2024-11-07","2023-05-09","2023-05-09","2023-06-26","2024-02-07","2024-02-07","2023-03-13","2023-07-25","2023-06-13","2022-11-14","2022-10-21","2022-10-21","2022-09-12","2022-08-10","2022-07-29","2022-05-09","2022-07-27","2022-06-22","2022-05-18","2022-04-25","2022-01-10","2022-01-11","2022-01-19","2022-02-10"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","FLUCONAZOLE","","","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":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}