{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna R Drolet","gend":1,"currentgend":"","add":"9 SOUTH MAPLE ST","city":"Randolph","state":"ME","zip":"04346","dob":"1949-07-20","age":"","mstatus":"","insh":"10000034338","cliId":"","pno":2075827543,"cno":"","email":"declined@082924.com","ename":"","eno":"","pphy":"LONGFELLOW, KAREN A","ppno":2075826608,"pcpadd":"44 MATHEWS AVE,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49015233","pcpcounty":"","pcpid":"","pcpname":"GARDINER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9 SOUTH MAPLE ST","madd2":"","madd3":"","mcity":"Randolph","mstate":"ME","mzip":"04346","pcpfaxno":"","pcpnpi":1295049187,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4HD9K12CR14","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I7142","J432","I7140","F17219","Z7951","M810","J439","I2510","I080","Z01818","I7143","N281","Q438","J449","I5032","Z09","I10","F17200","J441","R911","E0590","H5212","Z0100","H2511","H04123","Z95820","R942","F17210","R0989","E041","Z720","Z9849","R059","I700","Z955","E042","Z122","N854","R0689","H25811","Z780","Z0389","D2339","R079","R0602","E785","L570","Z0000","R4182","R636","Z9981","J189","J9611","I708","R918","R590","R0600","R6889","E0500","N200","D229","J440","M2042","L84","Z79899","K649","F419","B370"],"date":["2025-08-21","2025-03-04","2025-09-02","2025-03-04","2025-03-04","2025-08-27","2025-08-15","2025-06-21","2024-10-23","2024-12-26","2024-10-22","2023-01-11","2023-01-11","2025-11-13","2025-10-29","2024-04-02","2025-10-08","2025-06-24","2025-06-24","2025-10-28","2025-05-14","2024-05-09","2025-05-12","2024-12-03","2024-12-03","2025-08-21","2025-11-13","2025-02-10","2025-02-06","2022-12-19","2025-10-28","2025-10-23","2025-06-21","2025-01-14","2025-01-14","2025-10-08","2024-02-12","2023-12-06","2025-06-21","2025-09-17","2024-06-28","2024-04-09","2024-08-22","2024-03-24","2024-03-24","2025-09-17","2024-08-22","2024-02-09","2025-01-02","2025-01-03","2025-01-03","2025-07-21","2025-07-21","2025-01-02","2025-06-21","2025-06-21","2025-06-21","2023-05-12","2025-10-08","2025-01-28","2024-02-14","2025-06-21","2024-08-21","2024-08-21","2024-07-26","2022-11-18","2022-11-18","2022-08-11"],"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":[["","","METHIMAZOLE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ATROVENT HFA","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","FLUTICASONE-VILANTEROL","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL HFA","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","DULERA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","COMBIVENT RESPIMAT","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","MODERNA 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":""}]}]}