{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra L Hutchinson","gend":1,"currentgend":"","add":"179 GODING RD","city":"Lebanon","state":"ME","zip":"04027","dob":"1946-05-07","age":"","mstatus":"","insh":"10000012632","cliId":"","pno":2074572038,"cno":"","email":"greenthumb68@metrocast.net","ename":"","eno":"","pphy":"GIBSON, AMANDA R","ppno":2074907998,"pcpadd":"MaineHealth Primary Care Family Medicine,25A June St Ste 111","pcpcity":"Sanford","pcpstate":"ME","pcpzip":"04073","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"179 GODING RD","madd2":"","madd3":"","mcity":"Lebanon","mstate":"ME","mzip":"04027","pcpfaxno":2074907999,"pcpnpi":1356796353,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4DX7YC5JH63","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z936","Z8551","S52502A","L570","Z0000","E785","M25519","R011","L820","D489","Z85828","E039","M25532","M25632","M25432","C44722","J329","H401211","H401223","H0015","S065XAA","J22","S52572A","I6200","S199XXA","S0083XA","S52692A","S52552A","X58XXXA","I700","F32A","Z780","Z23","Z1231","S3993XA","S3991XA","S299XXA","H353131","M25511","Z743","L989","Z136","M19011","Z1272","R87629","S62112D","M1812","Z0101","H5203","S52602A","M810","A6920","S52502D","S52602D","I499","H524","L821","H02831","H02834","S065X9A","S0990XA","S6992XA","F411","S52592D","S52612D","E7849","Z01419","C679","R197","S065XAD","R87619","H401123","R7303","Z1389","H259","H2511","H2512","H2513","H3530","S81801D","S81801A","I83018","L97818","R918","M8580","R911"],"date":["2025-10-08","2025-10-08","2025-11-14","2025-05-21","2024-10-04","2025-10-14","2023-04-06","2023-04-06","2025-11-17","2025-05-21","2025-11-17","2025-06-05","2025-11-14","2025-04-17","2025-04-17","2024-11-14","2023-11-09","2025-11-05","2025-11-05","2025-11-05","2025-03-12","2023-02-11","2025-02-01","2025-03-12","2025-02-02","2025-02-01","2025-02-01","2025-02-03","2025-02-03","2024-12-05","2024-12-05","2025-05-13","2025-10-16","2024-06-25","2025-02-01","2025-02-01","2025-02-01","2024-12-20","2023-05-31","2025-02-01","2024-10-24","2025-02-06","2023-04-21","2022-12-20","2024-01-18","2025-03-13","2025-11-14","2025-03-11","2025-03-11","2025-02-03","2025-06-05","2025-06-05","2025-03-19","2025-03-19","2024-09-11","2024-05-29","2024-11-20","2025-09-17","2025-09-17","2025-02-02","2025-02-01","2025-02-01","2024-08-30","2025-04-30","2025-04-30","2023-06-13","2022-12-20","2024-01-18","2024-08-02","2025-02-05","2024-01-18","2024-09-24","2023-10-18","2023-10-18","2022-09-21","2022-09-21","2022-09-07","2022-08-08","2022-08-08","2022-07-12","2022-06-08","2022-07-12","2022-06-21","2022-05-17","2022-05-10","2022-05-17"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","HYDROXYZINE HCL","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}