{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan A Pullen","gend":1,"currentgend":"","add":"65 CENTRAL ST","city":"HALLOWELL","state":"ME","zip":"04347","dob":"1947-07-03","age":"","mstatus":"","insh":"10000018963","cliId":"","pno":2072426988,"cno":2074801022,"email":"susanpullen7347@gmail.com","ename":"","eno":"","pphy":"TRELEASE BELL, AMY L","ppno":2076261561,"pcpadd":"15 E CHESTNUT ST,","pcpcity":"AUGUSTA","pcpstate":"ME","pcpzip":"43305736","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICINE INSTITUTE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"65 CENTRAL ST","madd2":"","madd3":"","mcity":"HALLOWELL","mstate":"ME","mzip":"04347","pcpfaxno":2076261849,"pcpnpi":1801994561,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1UP3F19PW87","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1231","J4540","L570","K5900","F419","K3184","K219","Z8719","H5203","H52223","H524","J45909","R1310","Z87891","K449","Z0101","Z0000","L602","M2011","Z538","L603","R197","Z1283","N6489","M2012","M2041","M2042","T182XXA","Z0001","M25461","K224","Z87898","M25561","I10","M25842","R928","R92332","L820","B070","Z872","R413","R9089","G9389","R110","R112"],"date":["2025-08-07","2024-08-12","2024-11-19","2023-07-17","2025-09-04","2025-04-01","2025-04-01","2023-07-17","2024-09-13","2024-09-13","2024-09-13","2024-07-29","2024-09-04","2025-04-01","2024-08-21","2023-05-11","2025-06-19","2024-10-03","2024-02-09","2024-09-04","2025-08-22","2024-05-01","2023-11-13","2025-08-13","2024-02-09","2024-02-09","2024-02-09","2024-09-04","2023-04-17","2024-07-19","2024-08-21","2023-04-13","2024-07-18","2024-07-18","2023-04-17","2025-08-13","2025-08-13","2022-11-08","2022-11-08","2022-11-08","2022-10-21","2022-10-21","2022-10-21","2022-09-29","2022-08-30"],"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":[["","","BREO ELLIPTA","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","SPIRIVA HANDIHALER","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","ESOMEPRAZOLE MAGNESIUM","","","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":""}]}]}