{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lisl P Fuson","gend":1,"currentgend":"","add":"385 MOSHER HILL ROAD","city":"FARMINGTON","state":"ME","zip":"04938","dob":"1946-07-11","age":"","mstatus":"","insh":"10000012957","cliId":"","pno":2077789652,"cno":"","email":"Lisl.p.fuson@gmail.com","ename":"","eno":"","pphy":"BIEN, STEPHEN J","ppno":"","pcpadd":"PO Box 9463,","pcpcity":"Belfast","pcpstate":"ME","pcpzip":"04915","pcpcounty":"","pcpid":"","pcpname":"WILSON STREAM FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"385 MOSHER HILL ROAD","madd2":"","madd3":"","mcity":"FARMINGTON","mstate":"ME","mzip":"04938","pcpfaxno":2077786535,"pcpnpi":1770564890,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9M97G95TE61","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","H35373","H2513","H468","M810","Z780","H469","M5136","M5451","R296","R2681","R404","L570","S01112D","D225","L814","L821","Z7189","E559","S199XXA","M5030","N951","E8352","E673","S0990XA","Z0001","I10","E785","D509","M5481","H5213","S01112A","G3189","F325","G3789","R030","Z23","Z719","Z0189","I6381","H353131","R6889","G3781","D485","L218","Z0000","G9389","G459","G8190","G319","Z1389","S00462A","W57XXXA","M25511","D229","Z9189","L989"],"date":["2025-01-30","2025-07-30","2023-06-21","2022-12-21","2023-03-14","2023-03-14","2023-07-27","2024-09-26","2024-11-14","2024-06-10","2023-09-14","2023-11-09","2025-05-27","2024-06-10","2025-05-27","2025-05-27","2025-05-27","2025-05-27","2024-03-20","2024-06-01","2024-06-01","2024-03-14","2024-02-21","2024-02-21","2024-06-01","2023-11-09","2024-06-30","2023-11-09","2023-11-09","2025-01-15","2025-01-30","2024-05-31","2023-06-15","2024-02-20","2024-05-24","2023-10-02","2024-05-31","2023-10-02","2022-12-29","2024-06-03","2025-07-30","2022-12-27","2025-09-11","2023-06-14","2023-06-14","2024-11-12","2024-06-03","2023-06-15","2023-06-15","2023-06-15","2024-03-20","2025-10-20","2025-10-20","2024-02-20","2022-12-22","2022-08-15","2022-08-15"],"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":[["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","MYCOPHENOLATE MOFETIL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AREXVY","","","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":""}]}]}