{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leeann M Mcintosh","gend":1,"currentgend":"","add":"123 WATERBORO RD APT 501","city":"Alfred","state":"ME","zip":"04002","dob":"1952-06-17","age":"","mstatus":"","insh":"10000032467","cliId":"","pno":2078509024,"cno":"","email":"leeannmcintosh116@gmail.com","ename":"","eno":"","pphy":"LAZOS, SPIROS P","ppno":2074907998,"pcpadd":"SMHC Family Medicine,25A June St Ste 111","pcpcity":"Sanford","pcpstate":"ME","pcpzip":"04073","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"123 WATERBORO RD APT 501","madd2":"","madd3":"","mcity":"Alfred","mstate":"ME","mzip":"04002","pcpfaxno":2074907999,"pcpnpi":1912968967,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7X62RU1PT10","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4820","Z0000","R0689","E119","R0602","Z1231","M25532","I480","J441","R6889","D3121","H3540","H43392","I4710","I10","D3131","Z1211","Z0101","H5203","I4891","E785","R0989","H25813","Z7901","R000","R0600","I340","I501","I5189","I4892","D6869","J449","M7062","L280","M8589","I499","J301","M65311","G5601","J209","Z01812","Z20822","L299","L0100","I471","I493"],"date":["2025-05-24","2025-09-08","2025-06-16","2025-09-08","2025-06-16","2025-06-09","2024-04-01","2025-09-23","2025-10-31","2022-12-12","2022-11-30","2022-11-30","2022-11-30","2025-03-27","2025-06-03","2025-03-18","2025-10-02","2025-03-18","2025-03-18","2025-05-27","2025-06-03","2025-05-27","2025-03-18","2025-09-08","2025-05-24","2025-06-16","2025-05-26","2025-05-26","2025-05-26","2025-05-27","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-07-18","2025-05-29","2022-08-11","2022-03-28","2022-03-28","2022-04-01","2022-03-25","2022-03-25","2021-11-19","2021-11-19","2022-02-11","2022-02-11"],"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":[["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","ROFLUMILAST","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL HFA","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","DILT-XR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ONETOUCH DELICA","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","DALIRESP","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","BUSPIRONE HCL","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}