{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michele B Golden","gend":1,"currentgend":"","add":"62 CAVE HILL RD","city":"Waltham","state":"ME","zip":"04605","dob":"1947-07-22","age":"","mstatus":"","insh":"10000027739","cliId":"","pno":2079471695,"cno":2074040522,"email":"MICHELEGOLDEN47@GMAIL.COM","ename":"","eno":"","pphy":"ROCK, DARA L","ppno":2079073300,"pcpadd":"C\/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT,PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"62 CAVE HILL RD","madd2":"","madd3":"","mcity":"Waltham","mstate":"ME","mzip":"04605","pcpfaxno":2079071923,"pcpnpi":1376598540,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8V40VQ2XD25","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","K219","R1310","C50411","L821","R197","E6609","M9901","M542","M9903","M9902","L309","L280","N8189","N3941","Z853","Z170","Z923","Z803","Z1231","E669","M19012","L219","Z0000","R739","E785","E039","M19011","D229","L814","R600","Z0101","Z08","J0190","R911","M25512","I081","I2720","R2243","G4730","N9089","M8580","H6521","Z09","Z96643","R413","C50919","N814","L900","G8929","R5383","Z9011","M25551","R29898","Z780","M8588","Z98890","M25511","J439","J8410","R918","K317","K449","K2090","K222","N3946","Z4689","H6500","R051","N904","L259","Z20822","J069","S46811A"],"date":["2024-03-08","2023-09-26","2023-06-22","2022-11-30","2023-11-22","2024-05-02","2023-08-07","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2024-03-26","2025-03-14","2023-09-13","2023-09-13","2024-06-06","2022-11-30","2023-07-07","2023-01-06","2024-12-20","2023-09-12","2025-07-14","2025-04-25","2025-02-27","2024-02-22","2024-06-27","2024-02-22","2025-04-09","2025-04-25","2025-04-25","2023-05-22","2025-06-11","2024-01-16","2024-11-14","2024-12-05","2024-06-27","2023-03-24","2023-03-24","2023-05-22","2023-09-26","2023-09-13","2023-02-16","2023-02-16","2024-03-04","2023-08-28","2024-06-27","2025-02-27","2024-06-06","2024-06-06","2024-04-11","2022-11-15","2023-01-06","2023-09-26","2023-09-26","2024-12-20","2024-12-20","2024-01-16","2025-04-09","2024-12-05","2024-12-05","2024-12-05","2023-06-22","2023-06-22","2023-06-22","2023-06-22","2025-03-14","2025-03-14","2023-12-12","2023-12-12","2023-09-13","2023-05-18","2022-09-26","2022-09-26","2022-08-31"],"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":[["","","MIRABEGRON ER","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","LETROZOLE","","","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":""}]}]}