{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anne M Demers","gend":1,"currentgend":"","add":"8 RUE BEE RIDGE RD","city":"Windham","state":"ME","zip":"04062","dob":"1949-05-19","age":"","mstatus":"","insh":"10000033279","cliId":"","pno":2077494113,"cno":"","email":"mrrldemers@aol.com","ename":"","eno":"","pphy":"ZEITLIN, JAMES","ppno":2077745816,"pcpadd":"100 FODEN ROAD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062327","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 RUE BEE RIDGE RD","madd2":"","madd3":"","mcity":"Windham","mstate":"ME","mzip":"04062","pcpfaxno":2078741483,"pcpnpi":1194794859,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6VM7R52JK75","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J189","M9902","M5414","Z23","I10","M1990","G4733","E6601","Z9189","M5451","M62830","M5127","R0609","Z1211","K5730","K644","K648","M170","M1712","E668","M9903","M5126","M25552","S0003XA","M9901","M5412","Z6842","R4182","M25561","M25562","R262","M6281","R0600","Z0100","Z0001","M9904","M5417","M1711","R2689","R110","I480","Z86711","Z7982","L910","S4991XD","M79601","R6889","B078","R269","M19011","M19012","H579","L299","T148XXA","Z1231","M62838","L570","M5416","Z13220","Z7901","R0902","R7989","I2699","N952","L292","D485","N3946","M25661","M25662","R918","I2693","M25512","R21","L820","L918","D225","R350","M4317","N3941"],"date":["2025-02-25","2024-10-31","2024-10-31","2025-09-12","2025-09-12","2025-09-12","2025-09-12","2025-09-12","2025-08-29","2025-06-06","2025-06-06","2025-06-06","2025-05-23","2024-08-15","2024-08-15","2024-08-15","2024-08-15","2024-04-23","2024-04-23","2024-04-15","2025-11-03","2025-11-03","2024-10-10","2024-10-10","2025-11-07","2025-11-07","2024-08-15","2024-08-15","2024-07-08","2024-07-08","2024-07-08","2024-07-08","2025-05-23","2025-11-06","2025-03-27","2025-10-27","2025-10-27","2024-03-21","2025-10-15","2025-10-15","2025-07-02","2025-07-02","2025-07-02","2024-01-17","2024-11-21","2024-11-21","2023-01-16","2025-10-21","2025-10-15","2024-10-22","2024-10-22","2025-10-13","2025-10-13","2024-10-10","2024-10-24","2025-05-14","2025-01-13","2025-05-15","2025-03-27","2025-03-27","2024-11-03","2024-11-03","2024-11-18","2025-08-29","2024-08-27","2024-01-17","2023-08-28","2024-06-06","2024-06-06","2024-11-03","2024-11-03","2023-03-16","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-10-18","2022-07-27","2022-06-14"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","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":""}]}]}