{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Theresa B Boettner","gend":1,"currentgend":"","add":"826 DOUTY HILL RD","city":"SANGERVILLE","state":"ME","zip":"04479","dob":"1948-01-12","age":"","mstatus":"","insh":"10000024656","cliId":"","pno":2075648666,"cno":2073430829,"email":"Rbboettner123@gmail.com","ename":"","eno":"","pphy":"THIBAULT, KATHLEEN S","ppno":2075282285,"pcpadd":"135 PARK ST,","pcpcity":"MILO","pcpstate":"ME","pcpzip":"44631729","pcpcounty":"","pcpid":"","pcpname":"KATAHDIN VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"826 DOUTY HILL RD","madd2":"","madd3":"","mcity":"SANGERVILLE","mstate":"ME","mzip":"04479","pcpfaxno":2079431002,"pcpnpi":1689616260,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4UV1XF4AP36","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z794","Z01810","Z01812","M1990","M19012","M19011","E0510","H6121","E10649","Z98890","E041","R7989","J209","Z13820","E1310","Z0001","I371","Z01818","Z96612","Z1231","R0781","M9908","E1010","Z9989","R079","A6920","R109","R160","N281","M546","R6889","E1110","M7918","M25512","E785","J40","G319","R112","K5730","E1136","R1013","D72829","E876","M2550","R0789","E1165","Z0000","M25552","M2559","K2289","M8589","R053","G5601","E079","Z471","E11649","M1612","Z4789","Z0101","H109","G609","E119","Z96659","G5603","G5623","E1142","E042","Z1383","Z7984"],"date":["2023-05-12","2024-10-16","2024-10-16","2024-10-16","2024-11-05","2023-06-23","2024-10-24","2025-04-16","2025-09-04","2025-02-03","2025-08-29","2023-06-27","2024-10-11","2024-10-09","2023-04-11","2024-09-05","2023-11-08","2024-09-17","2025-03-10","2025-06-23","2024-11-16","2023-11-10","2023-04-05","2023-04-03","2024-09-18","2023-11-08","2023-08-01","2023-08-01","2023-08-01","2023-08-03","2023-02-13","2023-04-03","2023-08-01","2025-03-10","2023-04-05","2025-02-12","2023-04-03","2023-04-03","2023-04-03","2025-03-20","2023-04-11","2023-04-11","2023-04-11","2023-08-15","2023-08-22","2025-08-29","2025-08-29","2024-06-19","2023-08-15","2023-07-11","2024-10-09","2025-02-08","2024-07-30","2023-06-27","2024-11-27","2023-03-13","2024-07-24","2024-07-30","2023-03-15","2024-01-18","2024-06-19","2024-08-26","2024-08-26","2024-03-27","2024-03-27","2024-03-27","2023-01-16","2025-02-12","2022-09-12"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUBLOK TRIVALENT 2024-2025","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","NOVOLOG MIX 70-30 FLEXPEN","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","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":{"indx":[],"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":""}]}]}