{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jacqueline J Wilson","gend":1,"currentgend":"","add":"37 PENWOOD DR","city":"Kennebunk","state":"ME","zip":"04043","dob":"1947-10-07","age":"","mstatus":"","insh":"10000019927","cliId":"","pno":2075689068,"cno":2079678197,"email":"","ename":"","eno":"","pphy":"CUTONE, JENNIFER A","ppno":2074673200,"pcpadd":"Internal Medicine of Southern Maine,2 Independence Dr Ste B","pcpcity":"Kennebunk","pcpstate":"ME","pcpzip":"04043","pcpcounty":"","pcpid":"","pcpname":"INTERNAL MEDICINE OF SOUTHERN MAINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"37 PENWOOD DR","madd2":"","madd3":"","mcity":"Kennebunk","mstate":"ME","mzip":"04043","pcpfaxno":2074673207,"pcpnpi":1003879909,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1YH7K81RC75","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","H5203","K869","I4891","R0609","I340","M9903","M9904","M47816","M47817","R9439","R079","I2510","M5137","Z780","R0600","R350","R32","N390","J320","T8469XA","R220","K862","D2362","D492","J3489","Z7901","B479","Z472","K3533","K5730","E039","R4182","K7689","M85852","Z0000","L439","R109","K5900","L738","L821","L728","Z85828","K3580","R519","Z23","E785","C44622","H52223","K3532","M419","M5134","C44612","N3941","I10","I361","I4821","I517","I499","I4820","L723"],"date":["2025-09-24","2025-09-24","2023-01-09","2025-09-21","2025-09-10","2025-09-10","2024-06-19","2024-06-19","2024-06-19","2024-06-19","2024-12-17","2024-12-17","2024-12-17","2023-11-21","2024-03-25","2023-11-06","2023-11-30","2023-11-30","2023-11-30","2025-05-22","2025-04-01","2025-05-22","2023-01-12","2024-02-13","2024-02-13","2025-04-01","2025-04-01","2025-05-22","2025-04-01","2025-11-07","2025-11-05","2025-04-01","2025-04-01","2023-01-09","2024-03-25","2024-11-25","2024-02-13","2025-11-05","2025-11-05","2024-11-18","2024-11-18","2024-11-18","2024-11-18","2025-11-06","2025-11-05","2024-11-25","2024-11-25","2022-12-15","2024-12-02","2025-11-06","2023-11-21","2023-11-21","2022-11-07","2022-11-07","2022-10-10","2022-10-10","2022-10-10","2022-10-10","2022-10-10","2022-07-19","2022-07-11"],"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":[["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}