{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marcia L Baxter","gend":1,"currentgend":"","add":"22 BUTTONWOOD LN","city":"LEWISTON","state":"ME","zip":"04240","dob":"1949-03-03","age":"","mstatus":"","insh":"10000033807","cliId":"","pno":2077842429,"cno":"","email":"marcia.baxter@gmail.com","ename":"","eno":"","pphy":"DUQUETTE, ADAM","ppno":2077847388,"pcpadd":"190 STETSON RD,","pcpcity":"AUBURN","pcpstate":"ME","pcpzip":"42107813","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"22 BUTTONWOOD LN","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":2077952043,"pcpnpi":1679884522,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2EQ8QR9AX58","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F329","F411","J45909","R053","R918","M85852","R300","R5383","M8588","R319","L821","L570","X32XXXA","I788","R911","M1711","M1712","R6889","Z1211","Z1212","D122","E785","Z0000","H35362","I10","E039","H6122","Z1231","F331","K5730","K621","F419","E8801","L814","D235","D2361","M7989","H35013","N3090","H43393","M170","L820","R208","L538","K219"],"date":["2023-11-15","2024-08-05","2025-11-11","2025-11-03","2025-11-03","2024-01-16","2025-07-31","2023-09-12","2024-01-16","2025-08-04","2025-06-04","2024-11-14","2024-11-14","2024-03-29","2025-09-25","2023-06-29","2023-06-29","2023-04-06","2025-05-21","2025-05-21","2025-05-21","2025-01-08","2025-01-08","2025-06-05","2025-01-08","2025-09-10","2024-11-22","2024-11-26","2024-01-05","2025-05-21","2025-05-21","2023-11-15","2023-10-12","2025-06-04","2025-06-04","2025-06-04","2023-10-25","2024-05-23","2025-06-29","2023-05-18","2023-03-01","2025-06-04","2025-06-04","2025-06-04","2022-09-16"],"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":[["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE OIL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","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":""}]}]}