{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary L Audet","gend":1,"currentgend":"","add":"52 ELM ST UNIT 313","city":"WATERVILLE","state":"ME","zip":"04901","dob":"1949-06-12","age":"","mstatus":"","insh":"10000025684","cliId":"","pno":2076165771,"cno":"","email":"maryleeaudet68@gmail.com","ename":"","eno":"","pphy":"DUNN, ALISSA E","ppno":2074533100,"pcpadd":"Maine Dartmouth Family Medicine,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"52 ELM ST UNIT 313","madd2":"","madd3":"","mcity":"WATERVILLE","mstate":"ME","mzip":"04901","pcpfaxno":2074533082,"pcpnpi":1922634419,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9NC1HA0TX80","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H26492","C8339","Z79899","E039","E069","Z0001","Z5111","Z7689","C8338","Z961","H52223","H35372","M1990","R053","Z1231","R6889","C8330","K921","D696","M533","C8510","Z08","C8331","H26493","Z23","F32A","M8589","M25551","R0781","M546","C8590","M25552","F4320","R590","I10","F419","R7303","R221","K264","K449","K2980","H26491","Z1211","Z0101","Z4682","I2510","Z8572","Z9221","Z452","C8511","H43813","H40053","R591","M47812","R7402","K5730","D500","G629","E785","S29012A","S20212A","X58XXXA","R911","K760","R1013","E6601","F4321","R5381","R930","R1310","M810","Z636","Z6379","Z136","D649","Z0000","Z5941","R748","Z79630","Z79632","J988","Z5181","I517","K2950","B9789","L309","L299","R079","Z95828","N6459","Z8616","Z5112","H9202","J101","M542","M25512","N6321","M79672","M19072"],"date":["2023-02-01","2024-08-12","2024-05-15","2024-05-01","2024-04-09","2025-10-08","2024-02-07","2024-01-18","2023-12-04","2025-03-11","2025-03-11","2025-03-11","2024-11-04","2025-02-05","2025-03-17","2023-01-01","2025-02-10","2024-03-26","2024-08-12","2025-01-15","2024-08-08","2025-09-03","2024-12-26","2023-01-25","2022-12-28","2025-11-07","2024-09-27","2025-05-01","2025-07-24","2025-07-24","2024-09-12","2024-09-12","2025-10-02","2025-02-10","2023-08-29","2023-08-29","2025-04-22","2024-10-22","2024-03-26","2024-03-26","2024-03-26","2024-09-09","2023-01-18","2023-03-13","2025-02-10","2025-02-10","2025-09-03","2025-09-03","2025-04-09","2023-09-28","2023-01-17","2023-01-17","2023-12-04","2023-09-01","2023-09-21","2023-01-18","2023-12-01","2024-02-28","2025-10-09","2025-07-23","2025-07-23","2025-07-23","2025-08-25","2025-08-25","2023-12-01","2025-08-13","2025-08-13","2025-08-13","2024-12-26","2024-12-26","2025-09-18","2024-10-11","2025-01-29","2023-09-18","2023-11-27","2025-09-18","2025-09-18","2023-10-25","2023-10-25","2023-10-25","2025-01-29","2023-09-18","2023-09-18","2023-12-01","2025-01-29","2023-08-03","2023-08-03","2025-07-23","2025-07-23","2024-01-09","2025-02-26","2023-10-05","2024-06-27","2025-01-31","2023-10-04","2023-10-04","2024-01-09","2022-08-10","2022-08-10"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}