{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Melissa Berky","gend":1,"currentgend":"","add":"121 CRESTMONT RD","city":"Bangor","state":"ME","zip":"04401","dob":"1955-03-27","age":"","mstatus":"","insh":"10000012244","cliId":"","pno":2079495959,"cno":"","email":"berkmrb@gmail.com","ename":"","eno":"","pphy":"BARTLETT, TERESA M","ppno":2079073300,"pcpadd":"St Joseph Healthcare Internal Medicine,900 Broadway","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"121 CRESTMONT RD","madd2":"","madd3":"","mcity":"Bangor","mstate":"ME","mzip":"04401","pcpfaxno":2079071923,"pcpnpi":1386980829,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1WM3N38EE71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K529","R195","B349","M542","N72","N644","Z780","M810","H818X2","Z8616","E871","H906","R42","E785","Z0000","Z1231","F331","F5101","Z124","Z83719","R197","U071","H2512","H9072","M7918","S0590XA","Z1152","N950","Z79890","K5900","K7689","N281","H8120","M4802","M5011","M4722","M4312","J020","R6889","H2511","Z01419","G8929","R0981","J029","Z20822","M5412","H8102","M8580","L570","D1801","L821","Z7189","K52832","M8589","K6389","Z87891","Z803","Z0101","H524","H6592","H2513","H353131","R300","D225","L814","K648","L539","Z961","N841","M5416","M50123","U099","H9319","H905","M50322","M50323","M47812","R140","Z1151","M7989","H903","H6980","H9312","M25471","M25571","M19079","S82851S","T8484XA"],"date":["2024-07-16","2024-02-05","2023-10-14","2023-12-12","2023-08-01","2024-02-07","2025-04-29","2025-09-08","2023-05-16","2024-01-23","2024-03-12","2023-07-11","2023-07-11","2025-05-16","2025-04-22","2025-04-22","2025-08-04","2025-08-04","2023-05-15","2024-04-15","2025-04-18","2023-12-17","2025-07-07","2023-09-07","2023-07-27","2022-10-18","2023-10-14","2023-08-01","2023-08-01","2024-11-29","2025-06-11","2025-06-11","2023-04-11","2023-09-15","2023-09-15","2023-09-15","2023-09-15","2023-12-27","2023-02-16","2025-07-02","2025-09-08","2023-09-13","2023-04-21","2024-01-11","2023-04-21","2023-10-30","2023-12-14","2023-05-15","2024-04-02","2023-03-24","2024-04-02","2023-03-24","2025-07-25","2022-11-04","2025-07-25","2025-09-08","2024-06-10","2025-02-11","2025-02-11","2024-01-11","2025-05-22","2025-08-05","2023-01-02","2024-04-02","2024-04-02","2024-04-15","2024-04-15","2025-07-03","2023-08-01","2023-06-19","2023-09-08","2024-02-05","2022-11-11","2022-11-11","2023-08-02","2023-08-02","2023-08-02","2024-01-23","2023-05-15","2022-08-19","2022-08-12","2022-09-09","2022-08-09","2022-08-19","2022-08-19","2022-08-19","2022-08-19","2022-08-19"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","ESTRADIOL (TWICE WEEKLY)","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","BUDESONIDE DR","","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","LINZESS","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CHOLESTYRAMINE LIGHT","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","DOTTI","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","COMPRO","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","PROCHLORPERAZINE","","","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":""}]}]}