{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Margaret Valvo","gend":1,"currentgend":"","add":"15 MCKENZIE AVE","city":"FAIRFIELD","state":"ME","zip":"04937","dob":"1945-08-03","age":"","mstatus":"","insh":"10000013487","cliId":"","pno":2074536634,"cno":"","email":"valvo.robert@yahoo.com","ename":"","eno":"","pphy":"PISCULLI, JENNY T","ppno":2078615000,"pcpadd":"Maine Dartmouth Family Medicine,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 MCKENZIE AVE","madd2":"","madd3":"","mcity":"FAIRFIELD","mstate":"ME","mzip":"04937","pcpfaxno":2078615101,"pcpnpi":1538190384,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8YA6N22WM68","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1211","D124","I4891","R6889","N950","R9431","I10","C8800","K7460","D649","N1830","I4820","K648","I8500","K449","R188","H348112","H43813","H3561","K635","C880","K766","I129","J90","Z1152","K769","N289","D1803","J948","K7689","K862","Z1289","R0602","Z789","Z743","Z0000","E785","E039","L309","N858","R778","H348110","H34231","H26491","K7469","H26492","L509","Z87891","I088","Z7901","Z5181","Z01810","R160","R109","R112","R197","K652","D472","N854","N939","Z780","B070","L600","J929","J9811","Z0101","Z98890","D509","D225","L821","L814","Z7189","L820","R208","L538","R9389","M7918","N189","R531","R5381","R911","K649","R1032","K7290","K7210","M8589","H34213","C220","G319","I517","H348192","H539","Z48813","Z452","C8801","K644","R159","J9601","C8300","D72819","E8352","C8306","Z8709","K760","R0600","R55","I9581","H527","D2371","N179","K623","Z08","Z85828","L570","D485","Z79899","Z1159","N261","Z09","M79674","B351","D6869","M19041"],"date":["2023-02-07","2023-02-07","2025-11-04","2023-09-11","2023-11-07","2023-11-07","2023-11-07","2025-10-10","2025-10-10","2025-10-10","2025-10-10","2024-08-05","2024-04-22","2023-02-16","2024-11-12","2025-10-15","2025-03-07","2025-03-07","2025-03-07","2023-02-07","2024-07-19","2025-08-27","2025-08-27","2025-08-28","2024-12-04","2024-10-10","2024-10-10","2024-12-07","2025-08-28","2024-12-07","2024-12-07","2023-07-19","2025-02-25","2025-08-27","2024-12-04","2024-09-24","2023-10-02","2024-10-31","2023-07-07","2023-11-14","2025-10-10","2025-10-06","2025-06-12","2023-11-28","2025-02-27","2024-07-02","2023-07-10","2024-09-18","2023-11-10","2025-02-25","2024-07-08","2023-11-10","2024-11-12","2024-11-11","2025-08-27","2024-11-11","2025-08-28","2023-09-05","2023-09-22","2023-10-12","2023-10-04","2023-01-11","2023-01-11","2024-12-20","2025-02-25","2023-10-24","2025-06-11","2025-06-27","2025-06-24","2025-06-24","2025-06-24","2025-06-24","2025-06-24","2025-06-24","2025-06-24","2023-09-22","2024-05-02","2024-04-19","2025-08-27","2025-08-27","2025-03-10","2024-04-19","2024-11-12","2025-02-27","2024-11-12","2023-10-04","2025-03-28","2024-12-04","2025-03-28","2025-03-28","2025-03-28","2025-03-28","2024-12-06","2024-12-06","2025-07-17","2024-04-22","2024-04-22","2025-08-28","2025-02-20","2025-02-20","2025-01-28","2025-02-20","2025-02-25","2023-12-11","2025-08-27","2025-01-20","2025-01-20","2024-05-02","2023-03-08","2024-09-18","2024-02-20","2023-03-08","2023-03-08","2023-03-08","2023-03-08","2025-08-08","2025-08-05","2024-08-29","2024-09-10","2022-11-07","2022-11-07","2022-06-30","2022-06-30"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","LACTULOSE","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","BRUKINSA","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","NADOLOL","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PLENVU","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","IMIQUIMOD","","","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":""}]}]}