{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean A Coleman","gend":1,"currentgend":"","add":"48 MOUNTAIN VIEW RD","city":"Gray","state":"ME","zip":"04039","dob":"1948-07-10","age":"","mstatus":"","insh":"10000035270","cliId":"","pno":2072329943,"cno":"","email":"JEANACOLEMAN48@GMAIL.COM","ename":"","eno":"","pphy":"MOHAN, ELIZABETH A","ppno":2077745816,"pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"48 MOUNTAIN VIEW RD","madd2":"","madd3":"","mcity":"Gray","mstate":"ME","mzip":"04039","pcpfaxno":"","pcpnpi":1952622151,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5P42E30TP94","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":["R0683","R5383","I498","I480","H1131","R229","K117","R0982","R220","C73","E890","M25512","M79622","M25612","M6281","L910","R609","I10","I83813","I83893","Z0001","G44209","R404","H539","R4189","R1110","Z1231","K580","K219","K649","R197","I83811","I83891","D492","D1771","I83812","I83892","M8588","K5900","Z23","M19012","E854","M8580","Z7901","K909","R194","N644","R32","Z0101","R600","T8544XA","Z9882","H04123","L299","L820","E859","L720","Z124","E785","Z13220","R300","K644","K648","M2550","R140","Z981","K148","R42","R1310","Z9089","L600","M79672","M79671","H26493","D72819","F330","J029","Z20822","R6889","K2270","B070","H538"],"date":["2025-01-13","2024-12-04","2024-12-04","2025-09-09","2023-04-12","2024-09-19","2023-11-05","2024-05-06","2023-11-05","2025-06-10","2025-10-16","2025-10-20","2025-05-20","2025-05-20","2025-05-20","2024-06-28","2025-07-23","2025-10-16","2024-04-17","2024-04-17","2024-12-27","2025-10-16","2025-05-13","2024-08-08","2025-05-13","2024-06-24","2025-03-03","2025-10-22","2025-10-22","2025-04-03","2024-10-02","2023-05-09","2023-05-09","2024-06-28","2025-05-22","2024-09-19","2024-09-19","2024-12-27","2024-12-27","2024-12-27","2025-10-20","2025-10-20","2025-10-20","2025-10-20","2024-11-19","2025-01-30","2023-08-30","2023-08-22","2025-10-30","2025-07-17","2023-08-31","2023-08-31","2024-03-25","2024-04-10","2024-04-10","2024-04-10","2024-04-10","2025-07-31","2024-12-19","2023-12-11","2025-01-22","2025-10-22","2025-10-22","2025-10-16","2024-07-23","2024-09-19","2024-09-20","2022-11-10","2022-10-19","2022-08-10","2022-05-11","2022-04-12","2022-03-09","2022-03-02","2021-12-01","2021-12-01","2021-12-04","2021-12-04","2021-11-04","2021-12-21","2022-01-05","2022-01-26"],"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",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","SELENIUM SULFIDE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","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":""}]}]}