{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jo Ann Arno","gend":1,"currentgend":"","add":"6 URSULA ST","city":"WATERVILLE","state":"ME","zip":"04901","dob":"1947-03-18","age":"","mstatus":"","insh":"10000017508","cliId":"","pno":2076490777,"cno":"","email":"declined@11242025.com","ename":"","eno":"","pphy":"PRESTON, DAVID G","ppno":2078731098,"pcpadd":"Mid Maine Medicine,325B Kennedy Memorial Dr","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"THAYER INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"6 URSULA ST","madd2":"","madd3":"","mcity":"WATERVILLE","mstate":"ME","mzip":"04901","pcpfaxno":2078735461,"pcpnpi":1871559203,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7AK3AA2YP70","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5189","Z0001","C50812","H2513","F4323","K5010","I10","H2512","R102","R32","R350","R3915","H5231","N6323","S61451A","Z9012","C50412","Z170","D2271","Z1211","S61431A","W540XXA","G8918","C50512","K219","E039","C50912","R928","H35352","Z98890","N6489","L853","Z471","Z853","I890","K5730","Z08","Z860101","S72091D","Z86010","H8111","Z635","L03012","S72001D","Z8719","K5090","S72009A","D492","S0990XA","D225","L821","D1801","L814","N641","H2511","Z1231","L0292","F419","L989","L539","K2289","Z803","C50212","Z7183","Z800","Z0000","M79606","W1849XA","M80051D","W1809XD","M25551","S72001A","Z789","S72011A","Z01818","K5289","R110","E559","Z20822","J320","D580","M810","W228XXA","Z96641","W1831XA","L608","M79672","M79671","K1379","Z1239","S72041A","Z23","R0782","M549","K5900","R1010","R079","D122","D124","K529","K6389"],"date":["2024-12-29","2025-11-05","2024-04-16","2023-08-31","2024-04-10","2025-08-08","2025-03-12","2024-07-17","2025-09-11","2025-10-31","2025-09-11","2025-10-31","2023-08-31","2023-08-02","2023-03-26","2025-07-01","2025-07-25","2025-07-25","2024-12-06","2025-08-11","2023-01-10","2023-03-26","2023-09-12","2023-09-12","2025-03-12","2023-09-12","2024-04-24","2023-09-06","2025-10-29","2025-10-29","2023-09-08","2023-05-15","2023-07-11","2025-10-31","2025-09-04","2025-08-11","2025-07-01","2025-08-11","2023-05-08","2024-09-05","2025-03-12","2025-03-12","2023-11-17","2023-06-19","2024-09-05","2025-10-31","2023-07-05","2024-12-06","2025-05-21","2024-12-06","2024-12-06","2024-12-06","2024-12-06","2023-06-29","2024-07-31","2025-07-25","2024-04-24","2025-09-23","2024-07-02","2023-11-14","2025-02-19","2023-11-16","2024-01-03","2023-11-16","2023-11-16","2024-10-31","2023-04-04","2023-04-04","2023-04-20","2023-04-20","2023-04-05","2023-05-09","2023-04-05","2023-04-06","2023-09-06","2023-03-15","2023-03-15","2023-10-27","2023-04-04","2023-08-16","2023-06-19","2023-07-05","2025-05-21","2023-04-07","2023-04-05","2023-08-31","2023-08-31","2023-08-31","2024-09-07","2023-09-08","2023-04-08","2022-11-15","2022-09-20","2022-09-27","2022-09-27","2022-09-27","2022-09-20","2022-08-16","2022-08-16","2022-08-16","2022-08-16"],"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","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","BALSALAZIDE DISODIUM","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","LETROZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}