{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean Coltart","gend":1,"currentgend":"","add":"127 ACADEMY RD","city":"Monmouth","state":"ME","zip":"04259","dob":"1947-05-07","age":"","mstatus":"","insh":"10000017507","cliId":"","pno":2079333293,"cno":"","email":"sunflower18@roadrunner.com","ename":"","eno":"","pphy":"FLETCHER, CHRISTINE","ppno":2076243800,"pcpadd":"Winthrop Family Medicine,16 Commerce Plaza Ste 3A","pcpcity":"Winthrop","pcpstate":"ME","pcpzip":"04364","pcpcounty":"","pcpid":"","pcpname":"WINTHROP FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"127 ACADEMY RD","madd2":"","madd3":"","mcity":"Monmouth","mstate":"ME","mzip":"04259","pcpfaxno":2076243845,"pcpnpi":1497068506,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7MG1VM9WA04","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L309","L821","M1712","R059","M542","J22","R1310","K130","M25562","D122","Z1211","L853","M47812","E039","J40","S161XXA","R0981","Z1231","M79672","M7732","S60455A","L03012","W458XXA","R0989","R21","M25551","W19XXXA","R4582","L299","R351","R198","M79671","M7731","R0689","H524","Z0101","B070","Z96641","L304","L708","R319","E559","G2581","I10","K5730","H43812","Z0100","H04123","M2040","S93601A","X58XXXA","M19072","M5030","R42","X501XXA","R5383","Z0000","I70203","R350","S61217A","M2041","M7060","M2042","L851","L0100","B372","J069","S8012XA","W182XXA","S41112A","L989","R4589","J3489","R067","S80212D","S80211D","W19XXXD","R220","B354","M7742","S80212A","R6889","Z20822","Z4789","L918","S80211A","S161XXD","D1030","R195","W268XXA","W1789XA","Y9389","R519","J392","L259","M810","R062","R630","H938X2","L980","M25561","E669","M2012","G4489","T6701XA","R110","M25511","L539","M21062","L03211","Z23","R030","F419","R197","R1030","M79621","R490"],"date":["2025-09-22","2025-09-22","2024-05-29","2025-11-07","2023-11-17","2025-09-17","2024-02-26","2025-08-04","2024-05-29","2023-05-17","2023-05-17","2025-03-10","2023-11-17","2025-10-02","2024-01-12","2023-08-11","2025-11-07","2025-08-21","2025-04-24","2024-09-30","2025-07-04","2025-07-04","2025-07-04","2025-09-04","2025-09-04","2025-08-26","2023-08-11","2025-01-27","2025-06-30","2023-01-09","2025-04-22","2022-12-15","2022-12-15","2024-10-11","2023-04-13","2025-10-31","2022-12-15","2025-08-26","2025-06-19","2025-06-19","2025-06-30","2025-10-02","2025-10-02","2025-10-02","2023-05-17","2024-08-01","2024-08-01","2025-10-31","2022-12-15","2022-12-15","2025-08-14","2024-09-09","2023-11-17","2025-11-04","2023-11-17","2024-01-08","2025-06-20","2024-06-06","2025-06-30","2025-07-17","2024-11-11","2025-04-29","2024-08-20","2023-10-18","2025-07-28","2025-05-29","2025-02-03","2025-08-16","2025-08-16","2025-08-14","2025-08-14","2023-03-22","2023-01-30","2023-01-30","2023-07-24","2023-07-24","2023-07-24","2025-07-28","2025-09-21","2024-08-20","2023-07-17","2023-02-12","2024-01-05","2024-11-11","2024-12-16","2023-07-17","2023-09-13","2023-06-21","2025-10-15","2025-07-16","2023-07-13","2023-07-13","2025-07-31","2023-01-24","2024-10-03","2025-08-21","2024-01-08","2024-01-08","2023-04-18","2024-05-29","2023-10-02","2023-10-02","2024-07-18","2025-07-31","2025-07-31","2025-07-31","2022-11-29","2023-04-18","2023-05-30","2025-07-31","2025-06-20","2023-05-30","2025-10-15","2022-09-17","2022-09-17","2022-09-08","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":[["","","FLUCONAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO 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":""}]}]}