{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra M Leonard","gend":1,"currentgend":"","add":"147 DOGFISH HEAD RD","city":"SOUTHPORT","state":"ME","zip":"04576","dob":"1943-04-16","age":"","mstatus":"","insh":"10000023010","cliId":"","pno":2073504102,"cno":"","email":"Smbleo43@gmail.com","ename":"","eno":"","pphy":"RIKER, KERRY S","ppno":2079073300,"pcpadd":"St Joseph Internal Medicine,900 Broadway Bldg 5","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 205","madd2":"","madd3":"","mcity":"SOUTHPORT","mstate":"ME","mzip":"04576","pcpfaxno":2079071923,"pcpnpi":1033199591,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1HV2RJ1RC96","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01818","I480","I080","I5030","M65311","M25519","Z96612","N289","Z0000","I82609","I2720","Z96619","R931","G4733","Z471","M25512","R400","I82611","E785","L723","M75102","E0590","M79644","Z1231","R079","M19012","J984","L089","Z79899","S6991XA","Z0100","G8918","M75122","D6869","M25562","Z4789","M7989","Z96652","I081","R0683"],"date":["2024-08-12","2025-11-11","2024-01-22","2024-01-22","2023-04-03","2024-05-07","2025-07-31","2024-06-20","2025-02-12","2023-10-20","2023-10-18","2024-12-04","2023-05-24","2025-08-01","2025-07-31","2025-07-31","2025-08-01","2023-10-20","2024-06-20","2023-06-29","2024-08-12","2024-06-20","2023-03-06","2025-03-14","2023-01-30","2024-08-23","2025-02-12","2023-06-29","2023-06-23","2023-03-06","2025-04-18","2024-08-23","2024-08-23","2024-05-29","2025-01-31","2024-10-31","2025-01-31","2025-01-31","2022-09-13","2022-08-12"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PRADAXA","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","NOVAVAX COVID 2023-2024 (EUA)","","","Select","Select",""],["","","DABIGATRAN ETEXILATE","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLECAINIDE ACETATE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}