{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Margaret L Felts","gend":1,"currentgend":"","add":"78 FOX CROSSING ROAD","city":"Bridgton","state":"ME","zip":"04009","dob":"1948-09-28","age":"","mstatus":"","insh":"10000020939","cliId":"","pno":2076938012,"cno":"","email":"","ename":"","eno":"","pphy":"MATUSOVICH, CHARLES S","ppno":2078566010,"pcpadd":"North Bridgton Family Practice,14 Wyonegonic Rd","pcpcity":"North Bridgton","pcpstate":"ME","pcpzip":"04057","pcpcounty":"","pcpid":"","pcpname":"NORTH BRIDGTON FAMILY PRACTICE AND WALK IN CLINIC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 296","madd2":"","madd3":"","mcity":"Bridgton","mstate":"ME","mzip":"04009","pcpfaxno":2078579324,"pcpnpi":1134143514,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7A26EM2KA61","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0602","R059","J9601","R0609","R079","R399","N3000","N390","N12","R791","R0600","E876","I10","N281","N289","I700","M5450","Z7689","R350","R300","Z09","J449","I509","J984","R918","I2510","R7989","E785","R4189","J441","R519","J811","R0902","R001","R309","Z0389","R0789","S3992XA","M4854XA","M5136","S300XXA","R3915","R4182"],"date":["2025-10-15","2023-12-11","2025-01-15","2025-11-11","2023-10-14","2024-09-27","2024-11-12","2025-03-13","2023-12-05","2023-12-12","2024-05-12","2025-02-24","2025-10-02","2023-09-13","2023-09-13","2023-09-13","2023-09-07","2024-07-23","2024-06-14","2024-12-23","2025-01-30","2025-02-25","2025-01-17","2023-10-14","2023-10-14","2025-10-02","2023-10-14","2025-10-02","2024-10-02","2023-12-12","2025-01-16","2025-01-15","2025-01-15","2025-01-15","2024-03-06","2023-03-24","2022-10-27","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-09-14","2022-09-06"],"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",""],["","","FUROSEMIDE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","TRIMETHOPRIM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUTICASONE-VILANTEROL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","BREYNA","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}