{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jeannette M Bailey","gend":1,"currentgend":"","add":"162 STONEWALL DR","city":"ORRINGTON","state":"ME","zip":"04474","dob":"1944-12-03","age":"","mstatus":"","insh":"10000007706","cliId":"","pno":2079024199,"cno":"","email":"beetlejmb@yahoo.com","ename":"","eno":"","pphy":"Patten, John L","ppno":2078620300,"pcpadd":"ST JOSEPH FAMILY MEDICINE HAMPDEN,21 WESTERN AVE","pcpcity":"HAMPDEN","pcpstate":"ME","pcpzip":"04444","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"162 STONEWALL DR","madd2":"","madd3":"","mcity":"ORRINGTON","mstate":"ME","mzip":"04474","pcpfaxno":2077778800,"pcpnpi":1669577938,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1VA2W72PY28","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G459","I779","Z79899","I6523","F419","Z0000","H538","R29810","R29898","M9902","M546","M9903","M5386","K5520","D649","D509","Z8673","Z0101","H40013","Z23","M5442","M8589","Z09","I6529","J4520","Z1231","M25571","D62","S6992XA","S52502D","I63233","S99912A","R29818","M9905","B351","G8929","S52502A","R197","R413","F329","S52592A","Z872","F32A","Z780","R051","G20A1","K254","M25551","M25552","R0602","E785","K219","I493","I491","R918"],"date":["2024-09-17","2024-08-26","2024-08-26","2025-04-01","2022-10-14","2024-08-27","2024-08-25","2024-08-25","2024-08-25","2022-12-28","2025-03-03","2022-12-28","2022-12-28","2024-10-25","2024-11-18","2022-07-11","2024-10-03","2024-10-23","2024-10-23","2024-11-27","2022-12-16","2023-04-04","2024-10-21","2024-10-21","2024-10-21","2025-03-14","2024-11-29","2025-03-11","2024-10-14","2025-01-02","2024-08-25","2024-10-14","2024-08-25","2022-12-16","2022-12-16","2022-12-16","2024-11-01","2024-11-27","2022-10-14","2022-09-16","2024-10-30","2022-08-19","2022-10-14","2022-08-19","2025-02-19","2024-08-27","2024-10-14","2025-03-03","2025-03-03","2024-10-14","2023-08-25","2023-08-25","2024-10-04","2024-10-04","2025-03-14"],"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":[["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","PRIMIDONE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","PRAMIPEXOLE DIHYDROCHLORIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","JUBLIA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 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":""}]}]}