{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy W Cation","gend":1,"currentgend":"","add":"33 SPRUCE ST","city":"Bucksport","state":"ME","zip":"04416","dob":"1943-02-11","age":"","mstatus":"","insh":"10000016418","cliId":"","pno":"","cno":"","email":"nancywc77@gmail.com","ename":"","eno":"","pphy":"SZYLVIAN, CHADWICK J","ppno":2079073030,"pcpadd":"C\/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT,PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2076317896,"add2":"","add3":"","madd1":"33 SPRUCE ST","madd2":"","madd3":"","mcity":"Bucksport","mstate":"ME","mzip":"04416","pcpfaxno":2079073031,"pcpnpi":1205279056,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9V94JU1ET01","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H6121","C7A8","K529","D3A8","K2980","K2101","N813","C7B8","R918","K259","K269","K449","N200","C50912","Z170","N1339","K2091","K2950","K264","K921","K631","N132","K668","K2090","K2970","E43","E559","R112","R1012","R198","R262","K260","K922","N179","C7A092","Z466","Z87442","C7A010","H40021","H401122","N952","N6489","C50212","R935","D72829","K289","E538","K6389","R0602","Z20822","I447","R000","Z48815","K633","D62","K909","Z09","R339","Z79899","D372","H9042","C50512","C7B01","C7A00","K56609","R928","Z803","E164","Z960","K319","K2100","Z0101","H5203","H52223","H524","H40023","N6459","S52571D","S52614D","W000XXD","R911","R32","N819","Z0000","Z17411","Z23","H903","R590","C170","R739","E876","R933","R7401","H9190","S52611A","W000XXA","S52501A","G5601","J8410","K429","M2012","M2022","M2042","M24478","N1330","M19072","W010XXD","N6325","S52571A","S52614A","W010XXA","Z1211","Z860100","D123","K5730","R300","D122","K635","K5790","K648","Z86010","K640"],"date":["2023-07-24","2025-08-20","2023-02-13","2025-08-20","2023-06-28","2022-11-29","2025-08-19","2025-07-23","2025-02-28","2023-04-18","2023-04-18","2023-04-18","2025-01-30","2025-07-22","2025-07-22","2024-08-02","2023-02-15","2023-02-15","2023-02-15","2023-02-17","2023-02-25","2024-08-01","2023-02-18","2023-02-17","2023-02-17","2023-02-17","2023-03-20","2023-02-14","2023-02-14","2023-02-24","2023-02-24","2023-02-13","2023-02-21","2023-02-21","2025-01-30","2023-02-07","2023-02-07","2025-01-30","2025-07-16","2025-07-16","2025-08-19","2025-07-22","2025-08-15","2023-05-02","2023-02-14","2023-03-20","2023-03-20","2023-02-15","2023-02-18","2023-02-13","2023-02-15","2023-02-15","2023-02-25","2023-06-26","2023-03-14","2023-03-14","2023-03-14","2025-08-06","2025-03-27","2023-06-26","2023-06-06","2025-08-25","2023-05-12","2023-05-12","2023-05-12","2025-07-23","2025-08-25","2023-05-02","2023-01-10","2023-05-12","2023-04-18","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-05-29","2024-02-02","2024-02-02","2024-02-02","2024-01-30","2025-06-27","2025-06-27","2025-01-21","2025-08-25","2023-11-15","2025-06-10","2025-05-27","2023-09-12","2024-06-21","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2023-12-11","2023-12-11","2024-06-17","2024-06-17","2023-10-17","2023-10-17","2025-03-06","2025-03-06","2025-03-06","2025-03-06","2022-11-22","2025-03-06","2024-01-05","2025-06-30","2023-12-14","2023-12-14","2023-12-14","2025-09-22","2025-09-22","2025-09-22","2025-09-22","2022-12-05","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-09-13"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","TRAVOPROST","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}