{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Margaret E Schwally","gend":1,"currentgend":"","add":"49 HAMLYN DR","city":"WELLS","state":"ME","zip":"04090","dob":"1939-10-11","age":"","mstatus":"","insh":"10000016366","cliId":"","pno":2076366404,"cno":"","email":"LADYMARGARET39@YAHOO.COM","ename":"","eno":"","pphy":"CUTONE, STEVEN R","ppno":"","pcpadd":"1 MEDICAL CENTER DR,P.O. BOX 626","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"40059422","pcpcounty":"","pcpid":"","pcpname":"INTERNAL MEDICINE OF SOUTHERN MAINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"49 HAMLYN DR","madd2":"","madd3":"","mcity":"WELLS","mstate":"ME","mzip":"04090","pcpfaxno":2072829180,"pcpnpi":1831152743,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9WJ1KJ2FH32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G9589","R0789","K5730","R109","Z23","R0781","H401132","R5383","E039","I10","R9389","M810","R1030","Z0000","H2512","H401120","B351","G603","L851","Z8543","Z0101","R6889","R1032","R82998","H2511","H401112","H524","H4010X4","R531","Z7409","R590","M4804","M5124","J90","J9811","M48061","M47817","K5790","E785","E539","Z48815","G620","T451X5A","C7951","K8012","K828","R262","Z515","C799","R350","K5900","G629","R300","M170","K8510","K812","C569","Z1231","R079","R112","R52","R599","N281","R791","H2513","E663","E7849"],"date":["2025-07-25","2025-05-06","2025-05-18","2025-05-20","2025-01-13","2025-05-06","2024-12-03","2025-07-15","2023-11-03","2023-09-28","2023-09-28","2025-01-24","2023-06-27","2024-01-11","2022-11-17","2022-11-17","2025-03-05","2025-03-05","2025-03-05","2023-12-14","2024-05-30","2023-02-02","2023-06-14","2023-06-02","2022-10-20","2022-10-20","2024-05-30","2022-11-17","2025-07-21","2025-07-21","2024-03-25","2025-07-21","2025-07-21","2025-07-21","2025-07-21","2025-07-21","2025-07-21","2025-07-21","2025-01-24","2025-01-24","2025-07-02","2023-07-24","2023-07-24","2025-07-23","2025-05-23","2025-05-21","2025-07-22","2025-07-22","2025-07-22","2024-07-24","2023-09-08","2023-09-08","2024-07-16","2024-02-01","2025-05-23","2025-05-23","2023-08-09","2023-10-12","2025-05-22","2025-05-20","2025-05-20","2024-03-25","2025-05-20","2025-05-18","2022-08-31","2022-07-19","2022-07-19"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","MORPHINE SULFATE","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","BUPROPION XL","","","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":""}]}]}