{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dorothy G Stillman","gend":1,"currentgend":"","add":"44 TEMPLES WAY","city":"PALERMO","state":"ME","zip":"04354","dob":"1945-06-05","age":"","mstatus":"","insh":"10000023154","cliId":"","pno":2072425271,"cno":2072425271,"email":"declined@07152024.com","ename":"","eno":"","pphy":"CHENG, GENE","ppno":2076224400,"pcpadd":"6 Middle St,","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"GENE CHENG MD","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 127","madd2":"","madd3":"","mcity":"PALERMO","mstate":"ME","mzip":"04354","pcpfaxno":2076229894,"pcpnpi":1679534770,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6VW0G25GH32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","M25552","M810","M7062","M62838","M19011","R739","M8589","Z780","I480","Z0000","M069","Z79899","H6123","I4710","I493","M8580","E041","I4891","K529","N280","D72819","Z86718","I080","Z1231","M059","R202","Z0001","J9811","R059","J0190","B370","B9689","K5731","M25852","H31001","Z0100","R109","M5450","E039","K921","K2100","I4819","I998","I513","I340","R0781","I700","M25511","J029","S90562A","W57XXXA","E873","R7402","M25512","E876","N059","N200","R9431","R7401","R002","R6889","R051","I517","I3481","M1612","R410","R0989","Z0389","M75112","M7582","M19012","M779","I471","E785","D735","Z7901","I4719","Z743","D649","I743","Z79631","J988","B9789","E782","M7120","E559","E8342","R5383","J3489","R4182","K130","M0609","K5730","R1084","N281","K922","W000XXA","K625","D3132","H31011","H2513","R509","R21","I088","E663","R350","R300","R3915","Z87440","Z1331","S83242A"],"date":["2024-02-13","2024-05-13","2025-07-30","2024-08-16","2024-06-12","2025-10-08","2025-08-27","2024-05-16","2024-05-16","2025-09-29","2025-02-27","2025-02-12","2023-11-08","2025-07-31","2025-10-15","2025-10-15","2023-10-17","2023-10-17","2025-10-11","2024-02-11","2024-02-20","2024-02-15","2024-04-24","2023-06-20","2024-05-16","2025-09-30","2024-02-24","2025-08-26","2024-02-12","2025-08-12","2024-04-16","2024-04-16","2024-04-16","2024-04-22","2023-04-11","2023-01-06","2023-01-06","2024-02-20","2025-09-08","2023-11-21","2024-03-26","2024-03-26","2025-09-29","2024-03-08","2024-02-26","2024-02-26","2024-04-03","2024-04-03","2025-11-04","2025-08-12","2025-07-11","2025-07-11","2022-12-27","2025-09-18","2024-06-12","2024-03-27","2024-02-15","2024-02-15","2024-02-25","2025-09-16","2025-09-03","2023-01-16","2025-08-12","2024-02-12","2024-02-12","2023-04-11","2024-02-12","2024-02-12","2024-02-12","2024-07-27","2024-07-27","2024-07-27","2024-07-27","2023-02-03","2025-03-12","2024-03-07","2024-03-07","2024-03-25","2024-02-24","2024-08-22","2024-02-24","2025-09-30","2025-08-12","2025-08-12","2023-09-18","2023-01-25","2023-01-25","2024-03-11","2023-02-23","2023-02-23","2024-02-24","2025-04-22","2025-05-29","2024-02-11","2024-02-11","2024-02-11","2024-04-20","2024-04-03","2024-04-20","2024-08-07","2024-08-07","2024-08-07","2024-02-08","2025-04-03","2024-02-26","2022-10-26","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-08-15","2022-08-15"],"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":[["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TIADYLT ER","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","DILTIAZEM 24HR ER (LA)","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","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":""}]}]}