{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Suzan Bouley","gend":1,"currentgend":"","add":"250 MAXWELL RD","city":"LITCHFIELD","state":"ME","zip":"04350","dob":"1948-04-07","age":"","mstatus":"","insh":"10000025673","cliId":"","pno":2073758802,"cno":"","email":"declined@011723.com","ename":"","eno":"","pphy":"CLOUTIER, LISE M","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"250 MAXWELL RD","madd2":"","madd3":"","mcity":"LITCHFIELD","mstate":"ME","mzip":"04350","pcpfaxno":2077955727,"pcpnpi":1386624096,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4WY0WE4KX26","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","E7800","E1165","E039","M25811","M75101","E041","D72829","H26492","K435","M47816","R0602","Z20822","R82998","M7541","R1013","R109","K118","Z87440","M4802","M1712","R1084","Z1231","N390","K760","R300","K824","Z961","E119","M5450","I10","H26491","R079","R1010","E042","H25811","M549","R600","M25462","M23307","R059","R350","Z0101","M25569","Z932","K119","M546","H25812","H903","R52","N3001","M47819","H35372","M5114","M4724","M7531","M25511","M47814","E559","G8929","R102","R160","R1032","M47812","R0781","M5030","M4312","R0609","B9689","C50919","M5136","Z9011","E8352","R221","E1140","R000","R198","M2042","E785","Z01818","H538","K5190","M79672","D110","Z9013","M205X2","M216X2","L97521","E1142","E11621"],"date":["2025-02-05","2025-02-05","2025-09-09","2025-07-01","2025-07-28","2025-01-08","2025-05-14","2025-09-03","2023-05-25","2023-12-26","2023-04-07","2024-03-28","2024-03-28","2024-03-28","2024-07-24","2025-01-06","2025-06-23","2025-06-05","2025-03-31","2023-09-12","2023-10-06","2024-10-07","2024-10-25","2025-03-05","2024-12-11","2025-02-14","2024-12-11","2023-02-06","2024-07-22","2025-02-14","2025-06-23","2023-05-11","2024-05-02","2025-09-23","2023-06-19","2022-12-09","2025-10-16","2023-10-01","2023-10-01","2023-10-01","2023-03-15","2025-02-14","2025-09-03","2023-09-25","2024-11-15","2025-03-20","2023-12-05","2022-12-14","2023-01-09","2023-06-19","2025-01-23","2023-04-22","2025-09-03","2024-01-01","2024-01-01","2024-10-17","2025-07-28","2024-01-01","2024-05-02","2023-06-13","2023-06-13","2023-09-19","2023-09-19","2023-04-22","2024-02-02","2023-04-22","2023-04-22","2024-07-03","2025-01-23","2024-01-23","2023-03-29","2024-08-19","2025-08-06","2025-03-20","2023-01-25","2025-07-01","2025-07-01","2022-11-09","2022-11-09","2022-10-11","2022-10-04","2022-10-11","2022-09-16","2022-08-25","2022-08-18","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08"],"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":[["","","TRIMETHOPRIM","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","NOVOLOG MIX 70-30 FLEXPEN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRADJENTA","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","INSULIN ASPART PROT MIX 70-30","","","Select","Select",""],["","","INSULIN LISPRO PROTAMINE MIX","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ULTRA-FINE MICRO PEN NEEDLE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":{"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":""}]}]}