{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marilyn R Theibotot","gend":1,"currentgend":"","add":"12 S GROVE ST","city":"Augusta","state":"ME","zip":"04330","dob":"1939-08-22","age":"","mstatus":"","insh":"10000031101","cliId":"","pno":2076225929,"cno":"","email":"theibotot@aol.com","ename":"","eno":"","pphy":"TRELEASE BELL, AMY L","ppno":2076261561,"pcpadd":"15 E CHESTNUT ST,","pcpcity":"AUGUSTA","pcpstate":"ME","pcpzip":"43305736","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICINE INSTITUTE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 S GROVE ST","madd2":"","madd3":"","mcity":"Augusta","mstate":"ME","mzip":"04330","pcpfaxno":2076261849,"pcpnpi":1801994561,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2A91HH9FY27","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F411","M5450","M62838","R2689","G5612","G5602","F419","F32A","I10","G8929","M549","J309","R413","Z23","F909","J302","Z0000","E7800","E119","Z634","H6123","F4381","Z98890","J3489","H6993","J310","R439","F4321","M48061","R0981","R140","K219","E785","R5383","I879","R0683","F4320","H938X3","G4733","M5410","M542","S22089A","M5417","R350","X58XXXA","E8352","R7303","R0982","G5601","R002","R143","Z0100","R32","R0602","R10812","R10816","H6122","M26653","Z638","G5603","M65331","J45990","R0989","M8580","M4316","M9907","Z8616"],"date":["2025-09-10","2024-10-10","2024-10-10","2024-10-10","2024-11-07","2025-10-14","2025-06-19","2025-09-10","2025-04-07","2025-09-16","2024-04-24","2025-10-06","2025-10-06","2025-10-06","2025-09-10","2023-09-18","2024-11-27","2024-11-27","2025-08-14","2023-12-22","2024-05-09","2024-12-06","2025-10-14","2025-08-06","2025-08-06","2025-02-04","2023-08-03","2024-07-16","2025-10-16","2023-05-10","2024-07-16","2024-03-29","2025-04-07","2025-06-02","2023-09-01","2025-06-02","2024-02-07","2025-02-04","2025-09-03","2024-05-31","2023-04-19","2023-08-08","2024-04-18","2023-08-08","2023-08-08","2025-09-05","2022-12-05","2025-06-30","2022-12-19","2024-06-19","2024-06-19","2024-10-04","2023-12-26","2023-03-10","2023-06-16","2023-06-16","2025-06-30","2025-06-30","2024-04-16","2022-11-21","2022-11-21","2022-10-25","2022-10-12","2022-10-19","2022-09-22","2022-08-19","2022-08-19"],"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":[["","","AZELASTINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","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":""}]}]}