{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carmen D Smith","gend":1,"currentgend":"","add":"550 COLLEGE ST APT 106","city":"Lewiston","state":"ME","zip":"04240","dob":"1935-07-20","age":"","mstatus":"","insh":"10000031796","cliId":"","pno":2077771282,"cno":"","email":"","ename":"","eno":"","pphy":"DAVIS, MARY E","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":"550 COLLEGE ST APT 106","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":2077955727,"pcpnpi":1215917919,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2DV7KG8VJ62","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1811","Z0000","N390","R531","I4820","N1830","I10","M1712","I129","E785","E039","R2689","M6281","R5381","F4321","I4891","I428","F418","J449","R52","M1812","K5900","I9589","R5383","R42","R4189","I3481","F329","R059","R0789","R4182","D6869","H353133","M79606","Z23","R079","R0602","H43813","Z961","R262","I130","M159","R6889","M25562","H353190","M4126","M47816","M48062","Z981","I214","L299","I4510","I444","I440","I517","M533","M25551","R748","R778","I5020","J939","J810","I420","R001"],"date":["2023-06-26","2024-02-06","2025-08-13","2025-06-23","2023-10-17","2024-06-24","2025-07-10","2024-01-23","2024-02-06","2024-02-06","2025-08-13","2025-07-10","2025-07-10","2025-07-10","2025-07-10","2024-06-21","2023-06-12","2025-05-20","2025-07-14","2023-10-20","2023-07-10","2025-05-04","2025-07-10","2025-07-09","2025-07-09","2025-05-01","2022-12-21","2025-06-10","2024-06-21","2024-06-21","2025-06-23","2024-08-22","2024-09-10","2025-04-27","2025-02-11","2025-04-28","2025-04-28","2024-09-10","2024-09-10","2025-04-27","2024-08-22","2024-08-22","2023-08-02","2023-09-05","2023-08-01","2022-11-03","2022-11-03","2022-11-03","2022-11-03","2022-10-26","2022-10-26","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-19","2022-10-19","2022-09-18","2022-09-18","2022-09-18","2022-09-17","2022-09-17","2022-09-17","2022-09-09"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","DILT-XR","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","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":""}]}]}