{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brenda J Pyle","gend":1,"currentgend":"","add":"1052 PINE CIR","city":"Hermon","state":"ME","zip":"04401","dob":"1947-08-12","age":"","mstatus":"","insh":"10000018457","cliId":"","pno":2079912468,"cno":2078488174,"email":"hermonpond147@yahoo.com","ename":"","eno":"","pphy":"PARADIS, KENDRA M","ppno":"","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":"","add2":"","add3":"","madd1":"1052 PINE CIR","madd2":"","madd3":"","mcity":"Hermon","mstate":"ME","mzip":"04401","pcpfaxno":2077774397,"pcpnpi":1588012314,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4HT6XM7CN73","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R001","I4891","I700","I083","D485","I4811","R410","E6601","M25512","Z09","Z96653","M75102","Z5181","Z1231","M79605","E042","R053","R0982","M25552","I4819","E669","I080","I484","D225","L821","L814","L858","I4892","Z23","Z0000","I6523","R7309","K529","R42","R9089","M7918","I480","M5432","M9905","I493","Z0100","M7989","Z780","H26493","Z7901","Z79899","M5450","Z1211","Z1212","M25571","M79672","M7742","H26492","H43813","H26491","R6889","M159","I10","S46012D","W19XXXD","M7910","M533","R4182","M9901","M9902","M9903","M9904","R051","I471","R0600","E041","I491","I4710","X58XXXD","Z13820","M75112","R0781"],"date":["2023-05-12","2025-07-07","2023-04-07","2023-04-07","2025-05-14","2023-11-13","2023-08-18","2023-08-01","2024-05-24","2023-11-13","2023-09-07","2024-06-14","2025-05-30","2024-12-12","2023-06-02","2024-01-29","2024-07-05","2024-07-05","2022-10-31","2024-11-13","2023-10-24","2023-10-24","2023-10-24","2025-04-28","2025-04-28","2025-04-28","2025-04-28","2023-08-25","2023-01-25","2025-02-03","2023-08-29","2025-07-15","2025-07-15","2023-08-29","2023-11-20","2024-02-21","2024-08-05","2023-05-09","2023-05-09","2024-09-06","2025-01-28","2023-05-09","2024-12-12","2024-01-11","2024-08-05","2024-08-05","2023-09-07","2025-03-04","2025-03-04","2025-02-25","2025-02-25","2025-02-25","2024-01-18","2023-10-09","2024-01-11","2023-05-20","2024-06-04","2024-06-04","2022-10-31","2022-10-31","2023-06-06","2023-06-06","2023-08-18","2023-06-06","2023-06-06","2023-06-06","2023-06-06","2023-03-16","2023-03-16","2023-03-31","2024-01-29","2024-09-06","2024-09-06","2022-09-19","2022-09-30","2022-08-24","2022-08-24"],"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":[["","","FLECAINIDE ACETATE","","","Select","Select",""],["","","DOFETILIDE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DILTIAZEM HCL","","","Select","Select",""],["","","DIAZEPAM","","","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":""}]}]}