{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cynthia J Durost","gend":1,"currentgend":"","add":"15 COLONIAL CIRCLE APT 106","city":"BREWER","state":"ME","zip":"04412","dob":"1945-12-28","age":"","mstatus":"","insh":"10000019084","cliId":"","pno":2073079011,"cno":2073079011,"email":"cjdurost@gmail.com","ename":"","eno":"","pphy":"Collins, Amanda S","ppno":2079412373,"pcpadd":"EMMC HUSSON FAMILY MEDICINE,302 HUSSON AVE STE 2","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 COLONIAL CIRCLE APT 106","madd2":"","madd3":"","mcity":"BREWER","mstate":"ME","mzip":"04412","pcpfaxno":2079418803,"pcpnpi":1881960458,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1GD1FN3DJ80","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H9193","H6693","E785","Z970","Z1231","R002","Z20822","R051","R0981","J069","E039","M8580","F330","E018","M8589","Z0101","H18591","H25011","H2511","H43811","H52221","H524","Z0000","D224","L814","L738","L821","R6889","H4489","H6592","M25561","H5201","B078","L538","R238","Z789","Z09","Z872","R42","H9190","H9319","E782","M542","H9313","M9901","M9902","M9900","H9202","D485","L570","Z7189","M7910","M9907","M9908","H6980","M9903","H18521","M13861","H903","I4510","R058"],"date":["2023-07-18","2023-07-10","2025-04-01","2023-07-10","2024-03-15","2023-02-20","2024-06-10","2024-03-17","2024-03-17","2024-03-17","2025-04-01","2025-04-01","2025-04-01","2025-04-01","2025-04-30","2025-05-19","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2025-05-19","2025-05-19","2024-10-24","2024-04-05","2024-04-05","2024-04-05","2024-04-05","2023-01-01","2025-06-09","2023-07-08","2024-01-31","2025-05-19","2023-03-31","2023-03-31","2023-03-31","2023-03-31","2023-03-31","2023-03-31","2024-08-07","2024-08-07","2024-08-07","2024-10-15","2023-11-30","2023-11-30","2023-11-30","2023-11-30","2023-11-30","2022-12-30","2023-01-19","2023-01-19","2023-01-19","2023-10-10","2023-10-10","2023-10-10","2023-07-13","2023-11-30","2022-07-18","2024-01-05","2023-09-28","2023-01-11","2024-06-10"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","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":""}]}]}