{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cindy R Casterline","gend":1,"currentgend":"","add":"13 CRESCENT ST","city":"SKOWHEGAN","state":"ME","zip":"04976","dob":"1957-01-25","age":"","mstatus":"","insh":"10000009020","cliId":"","pno":"","cno":2074317066,"email":"chili_pepper522@yahoo.com","ename":"","eno":"","pphy":"Tomasz, Sarah M","ppno":2076344366,"pcpadd":"RMPC NORRIDGEWOCK HEALTH CENTER,87 MERCER RD","pcpcity":"NORRIDGEWOCK","pcpstate":"ME","pcpzip":"04957","pcpcounty":"","pcpid":"","pcpname":"RMPC NORRIDGEWOCK HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"13 CRESCENT ST","madd2":"","madd3":"","mcity":"SKOWHEGAN","mstate":"ME","mzip":"04976","pcpfaxno":2076344375,"pcpnpi":1144678970,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3UP5MJ6VX50","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L570","R296","M4726","R319","K5900","K2980","K319","R030","L309","L989","R1900","H353132","H26491","G4700","I10","R109","B379","E041","G894","R079","R7303","N138","N1330","N261","N2882","N136","N390","H35373","Z1231","Z0189","Z87440","M21372","C44519","Z0000","M79662","R1084","N12","M25511","M533","R6889","M25561","M48061","I77810","Z08","R0789","M948X6","S83011A","S83012A","M21162","D485","M5450","Z85828","Z87891","H26492","L820","N200","Z4802","C799","N2889","N281","K5730","E785","Z124","H019","J449","F419","H43813","N132","M7981","Z79899","R5383","R1032","K9289","M47812","M79601","M542","Z981","H26493"],"date":["2025-01-23","2023-01-24","2023-05-02","2022-10-03","2025-03-20","2025-06-02","2025-06-02","2022-10-10","2022-09-22","2024-07-18","2023-09-13","2024-12-19","2023-08-15","2022-07-20","2025-02-11","2024-09-18","2022-09-21","2024-02-20","2022-10-28","2024-01-29","2023-11-20","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-09-26","2024-04-18","2024-12-19","2024-08-15","2022-11-15","2025-06-04","2023-03-16","2025-02-25","2025-03-14","2024-03-08","2024-05-05","2022-10-21","2023-02-02","2024-03-19","2023-03-18","2022-12-09","2023-02-02","2024-09-30","2024-04-22","2024-01-24","2022-12-09","2022-12-09","2022-12-09","2022-12-09","2025-01-23","2023-02-02","2024-04-22","2024-04-22","2022-12-22","2025-01-23","2024-04-18","2024-08-01","2023-04-01","2023-04-01","2023-04-01","2023-04-01","2025-01-29","2022-12-08","2023-04-19","2023-04-25","2023-04-25","2024-06-19","2022-09-26","2023-04-01","2024-03-12","2024-02-05","2025-05-22","2025-04-01","2023-02-02","2023-02-02","2023-02-02","2023-02-02","2022-06-22"],"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":[["","","IBUPROFEN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","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":""}]}]}