{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Glennis M Veilleux","gend":1,"currentgend":"","add":"61 OAK ST","city":"Waterville","state":"ME","zip":"04901","dob":"1940-01-09","age":"","mstatus":"","insh":"10000010888","cliId":"","pno":"","cno":"","email":"gmbv@roadrunner.com","ename":"","eno":"","pphy":"LEBLANC, CHRISTINA","ppno":2078731098,"pcpadd":"MaineGeneral Medical Center,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"THAYER INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2078722845,"add2":"","add3":"","madd1":"61 OAK ST","madd2":"","madd3":"","mcity":"Waterville","mstate":"ME","mzip":"04901","pcpfaxno":2078615461,"pcpnpi":1154773935,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5P43FP7HQ15","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","M4726","M48061","I7140","M5116","D509","R5383","R252","R519","Z780","Z0001","I2510","I493","R0602","Z1211","H903","L570","Z0000","C44319","M5416","K5900","E785","M79652","M7062","M5136","M5450","H6122","R399","D259","Z1283","D485","Z85828","N858","R030","N888","N950","L738","R002","H40013","M810","H527","R309","N390","Z23","Z1272","Z1151","Z124","K2950","R918","H6123","R0600","M47816","R112","D649","I7143","H9319","R42","Z9221","E039","K219","K648","C187","E7800","R32","R109","K449","Z9049","N899","L859","D3131","I083","I77810","M51360","M5386","N859","I4710","C20","H04123","H43811"],"date":["2024-12-31","2023-02-16","2023-02-16","2025-10-14","2023-02-16","2025-11-04","2025-09-16","2025-09-16","2025-04-08","2023-01-10","2022-12-01","2025-04-08","2024-03-19","2024-12-31","2025-06-24","2025-04-28","2024-04-10","2024-12-17","2023-06-07","2025-09-24","2025-09-09","2024-05-02","2023-04-18","2023-04-18","2023-04-18","2025-09-24","2025-02-06","2025-08-11","2025-01-27","2024-03-14","2024-03-14","2024-03-14","2024-10-29","2024-02-26","2024-10-29","2024-10-29","2024-04-10","2024-12-31","2025-08-05","2023-01-10","2025-08-05","2025-03-21","2024-10-28","2024-11-20","2024-07-11","2024-07-11","2024-07-11","2025-10-16","2025-04-08","2025-02-12","2024-03-19","2025-11-02","2024-11-04","2025-06-12","2024-07-12","2025-02-25","2025-02-25","2025-02-25","2022-12-01","2025-10-16","2025-06-24","2023-12-07","2023-10-25","2025-03-21","2025-03-21","2024-04-29","2024-04-29","2024-07-11","2024-04-10","2025-08-05","2024-04-22","2024-04-22","2025-09-24","2025-09-24","2024-07-12","2025-01-13","2023-12-07","2023-03-30","2023-03-30"],"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":[["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)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":""}]}]}