{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia A Nugent","gend":1,"currentgend":"","add":"28 LUPINE LN","city":"Baileyville","state":"ME","zip":"04694","dob":"1943-07-26","age":"","mstatus":"","insh":"10000011097","cliId":"","pno":2074540096,"cno":"","email":"declined@05142025.com","ename":"","eno":"","pphy":"ROXAS, SHARON K","ppno":2079073777,"pcpadd":"EMMC Family Medicine of Brewer,234 State St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 LUPINE LN","madd2":"","madd3":"","mcity":"Baileyville","mstate":"ME","mzip":"04694","pcpfaxno":2079073778,"pcpnpi":1912211483,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8GE2J85KH88","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I214","R55","R200","G243","I10","I4891","Z7982","Z0000","Z23","I2510","E785","G459","E119","U071","M940","R079","Z743","Z9989","F419","F32A","I509","K5732","E1159","N281","M25551","G8929","M549","R1084","K5900","J209","R0602","Z955","I779","K5750","R058","E039","R102","I6523","Z9181","R251","R140","K5730","N952","R791","M25552","W19XXXA","M6282","I222","M5450","Z961","M5459","Z91041","Z91018","T796XXA","R0789","R4182","T148XXA","R531","M436"],"date":["2024-10-25","2025-08-01","2024-06-11","2025-06-25","2024-06-26","2022-10-27","2022-10-27","2024-04-16","2023-09-11","2024-10-25","2024-06-26","2024-04-22","2024-06-26","2024-09-22","2023-12-17","2025-06-16","2025-06-14","2024-09-10","2024-09-09","2024-09-09","2025-04-03","2023-11-28","2024-10-25","2023-11-26","2025-06-29","2025-06-25","2025-06-25","2023-11-28","2023-11-28","2024-03-15","2024-03-15","2024-03-15","2022-10-14","2023-12-17","2024-03-15","2023-09-19","2024-03-04","2023-10-17","2024-04-22","2024-04-22","2025-05-29","2025-05-30","2024-03-04","2025-06-17","2025-06-16","2025-06-16","2025-06-14","2024-09-10","2025-05-30","2024-02-12","2025-05-29","2025-05-30","2025-05-30","2025-06-16","2024-11-06","2024-11-06","2025-06-14","2025-06-14","2022-09-30"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PRIMIDONE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","RANOLAZINE ER","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LINZESS","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ISOSORBIDE DINITRATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","EUTHYROX","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","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":""}]}]}