{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beverly L Lavigne","gend":1,"currentgend":"","add":"16 BIRCHVIEW DR","city":"AUGUSTA","state":"ME","zip":"04330","dob":"1944-11-21","age":"","mstatus":"","insh":"10000022958","cliId":"","pno":2076227719,"cno":2076227719,"email":"Bev1721@roadrunner.com","ename":"","eno":"","pphy":"SMITH, CARLEN G","ppno":2076267400,"pcpadd":"Maine Dartmouth Geriatic Medicine,6 E Chestnut St","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH GERIATRIC MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"16 BIRCHVIEW DR","madd2":"","madd3":"","mcity":"AUGUSTA","mstate":"ME","mzip":"04330","pcpfaxno":"","pcpnpi":1295199453,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8FR4XE1EH70","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R079","R0989","K6389","M5417","M5416","H01111","H01114","H01112","H01115","I82462","Z48815","M51369","M47816","M1611","Z96641","K831","K311","Z9884","E43","K219","F1090","E860","K8050","N179","E512","E8720","K8309","K8031","E039","I10","F1097","I2510","Z87891","H109","K8030","K769","N281","R1013","Z9049","R188","K8689","K838","R918","R059","R0600","R932","R072","Z4689","K316","Z4889","R194","R110","D72829","R9431","I252","K8051","E785","L989","Z23","Z4659","K8020","Z789","K651","S3991XA","R160","D649","F1027","E7800","I959","E871","S90851A","D2230","L299","R109","K5641","K5730","R935","R69","J90","R0602","R9389","M79662","R1011","Z90710","I700","Z0100","H40013","F1026","F03A3","M5441","Z79899","F0393","F331","F419","F32A","F1010","G3184","R001","I440","R0689","R1084","R112","R52","N1830","L570","L814","L821","D229","Z7189"],"date":["2025-05-02","2023-10-09","2023-10-01","2025-05-08","2025-04-29","2025-10-22","2025-10-22","2025-10-22","2025-10-22","2023-11-09","2023-11-03","2025-04-29","2025-04-29","2025-04-29","2025-04-29","2023-10-02","2023-10-02","2023-12-20","2023-10-31","2023-10-31","2023-10-31","2023-10-31","2023-12-01","2023-10-30","2023-10-30","2023-10-30","2023-10-01","2023-10-02","2025-02-12","2025-05-19","2022-12-15","2025-05-19","2025-06-04","2025-07-12","2023-10-12","2023-10-30","2023-10-30","2023-10-30","2023-10-30","2023-10-12","2023-10-12","2023-10-12","2023-10-09","2023-10-08","2023-10-09","2023-10-09","2025-05-02","2023-12-20","2023-12-20","2023-10-04","2023-10-24","2023-10-24","2023-11-01","2023-09-30","2023-09-30","2023-10-01","2023-09-30","2025-02-21","2024-12-23","2023-12-20","2023-09-30","2023-09-30","2023-10-09","2023-10-09","2023-10-09","2024-12-27","2023-03-08","2025-05-19","2023-10-25","2023-10-25","2023-06-16","2023-06-16","2023-06-16","2023-11-03","2023-09-29","2023-09-29","2023-09-29","2023-11-08","2023-10-25","2023-10-25","2023-10-25","2023-11-09","2023-10-25","2023-10-25","2023-10-25","2024-10-21","2024-10-21","2023-06-21","2025-06-04","2025-06-04","2025-06-04","2024-06-26","2024-06-26","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-09-30","2023-09-30","2025-05-02","2023-09-29","2023-09-29","2023-09-29","2025-08-27","2022-10-17","2022-09-19","2022-09-19","2022-09-19","2022-09-19"],"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":[["","","FLUCONAZOLE","","","Select","Select",""],["","","LOTEMAX","","","Select","Select",""],["","","LOTEPREDNOL ETABONATE","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","XIIDRA","","","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":""}]}]}