{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kristeen M Jordan","gend":1,"currentgend":"","add":"48 TOURMALINE DR","city":"Lewiston","state":"ME","zip":"04240","dob":"1965-07-10","age":"","mstatus":"","insh":"10000023449","cliId":"","pno":2073452499,"cno":"","email":"Kjf2ndchance@gmail.com","ename":"","eno":"","pphy":"KASALABA, KEMA","ppno":2077958475,"pcpadd":"Minot Avenue Family Medicine,789 Minot Avenue","pcpcity":"Auburn","pcpstate":"ME","pcpzip":"04210","pcpcounty":"","pcpid":"","pcpname":"MINOT AVENUE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"48 TOURMALINE DR","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":2077958490,"pcpnpi":1023377397,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9M93NT9HH03","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","E119","E785","R21","Z9884","Z23","E663","E6601","G4733","E66813","Z713","R400","G4700","M25512","F329","I493","I10","L509","Z6830","M25519","R6889","U071","N202","E669","F32A","K5730","K769","N201","R932","R112","M797","Z87442","M9900","M9901","M9902","M9903","K909","M542","E662","Z6831","M179","N200","N1330","N179","N134","N132","K219","M1710","R3915","R3129","R109","K449"],"date":["2025-07-18","2025-08-07","2025-07-30","2023-12-01","2025-08-19","2025-10-13","2025-07-18","2024-08-01","2025-11-03","2025-08-07","2023-10-20","2025-08-04","2025-08-04","2025-08-18","2024-04-10","2025-07-24","2023-08-18","2023-11-22","2025-05-09","2025-07-24","2023-01-17","2022-10-25","2022-09-22","2022-09-27","2022-09-27","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2022-07-21","2022-07-20","2022-07-20","2022-07-20","2022-07-18","2022-05-24","2022-03-06","2022-03-06","2022-03-02","2022-03-02","2022-01-28","2022-01-28","2022-02-07","2022-02-07","2022-02-21","2022-02-10"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUCELVAX QUAD 2022-2023","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","VENLAFAXINE HCL","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","GABAPENTIN","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}