{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pamela L Peasley","gend":1,"currentgend":"","add":"39 CASSIDY LN","city":"Gardiner","state":"ME","zip":"04345","dob":"1943-01-29","age":"","mstatus":"","insh":"10000008671","cliId":"","pno":2074582793,"cno":"","email":"declined@12122024.com","ename":"","eno":"","pphy":"MURRAY JAMES, NATHAN R","ppno":2076260606,"pcpadd":"Hallowell Family Practice,9 Union St","pcpcity":"Hallowell","pcpstate":"ME","pcpzip":"04347","pcpcounty":"","pcpid":"","pcpname":"HALLOWELL FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"39 CASSIDY LN","madd2":"","madd3":"","mcity":"Gardiner","mstate":"ME","mzip":"04345","pcpfaxno":2076260022,"pcpnpi":1851376065,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9FK6VH2NQ49","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9901","M542","M9902","M7918","M86172","M2042","M9905","M5450","M9903","L97909","M6281","R262","U099","I4811","I10","T148XXA","L03116","E119","R29898","Z780","Z13820","L03119","R600","M1712","I509","I4891","E538","G4700","M160","M7060","M25552","M25551","Z4801","H5789","I088","H40013","H25812","Z23","J3489","Z1231","R5383","Z8639","L03032","M7989","L089","Z4781","Z89422","J329","E11621","H6991","E785","L309","Z0000","S98132A","H2512","L0889","Z0101","I428","L03115","H04123","S81812A","L97529","H524","H903","L97523","H259","H25813","H2511","H5213","H52223"],"date":["2023-12-28","2023-12-28","2023-12-28","2025-10-24","2025-08-26","2025-08-26","2025-10-24","2025-10-24","2025-10-24","2025-03-31","2023-05-08","2023-05-08","2023-05-08","2025-01-30","2024-09-20","2023-03-10","2023-03-20","2025-09-29","2025-01-03","2023-09-27","2023-09-27","2023-08-04","2023-03-20","2023-03-20","2024-07-29","2025-03-21","2024-11-25","2023-08-04","2024-04-16","2024-04-16","2024-04-16","2024-04-16","2025-09-18","2023-02-11","2025-01-30","2024-12-23","2025-06-16","2023-09-22","2024-12-02","2023-09-21","2024-11-25","2024-11-25","2025-08-04","2025-08-04","2025-08-05","2025-09-11","2025-09-11","2024-11-18","2025-10-20","2024-11-17","2023-06-23","2023-04-08","2024-07-29","2025-08-25","2025-06-10","2025-07-31","2024-12-23","2024-11-14","2025-03-04","2024-12-23","2023-03-10","2025-10-20","2025-07-07","2024-04-15","2025-08-25","2022-09-12","2022-09-19","2022-09-19","2022-09-02","2022-09-02"],"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":[["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MOXIFLOXACIN","","","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":{"indx":[],"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":""}]}]}