{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stephanie J Strout","gend":1,"currentgend":"","add":"12 Birch Dr","city":"Standish","state":"ME","zip":"04084","dob":"1950-08-10","age":"","mstatus":"","insh":"10000035301","cliId":"","pno":2076484295,"cno":"","email":"","ename":"","eno":"","pphy":"CHASE, SCOTT M","ppno":"","pcpadd":"582 ROOSEVELT TRAIL,","pcpcity":"WINDHAM","pcpstate":"ME","pcpzip":"04062","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 Birch Dr","madd2":"","madd3":"","mcity":"Standish","mstate":"ME","mzip":"04084","pcpfaxno":"","pcpnpi":1760584007,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9QF0FE8HT07","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D5912","E538","D702","Z5111","R350","R300","D649","E559","Z1211","F411","Z1231","R918","R079","Z0000","N3941","N952","N393","R3129","M7989","Z0101","R509","D709","U071","R5081","K8020","R161","F331","G629","F32A","A419","H2513","H16223","H43811","D120","D124","D472","R4182","R55","D849","K635","Z860101","R531","Z860100","M79662","F3341","F419","Z9884","Z803","M8580","E890","M79605","G4700","I808","R2232","M79644","H259","L570","D704","C91A0","H2511","H2512","N3281","Z961","M79601","R635","Z6826","D7581","R5383","F4323","Z23","Z780","Z1159","M8589"],"date":["2025-11-12","2024-12-09","2025-08-17","2025-04-22","2023-07-03","2023-07-03","2023-12-30","2024-12-20","2024-11-01","2025-08-01","2024-08-27","2025-07-01","2025-10-06","2025-10-06","2024-08-06","2024-08-06","2024-08-06","2023-06-30","2024-12-20","2025-11-10","2025-07-25","2025-08-19","2025-08-19","2025-08-19","2024-12-05","2024-12-05","2024-10-02","2023-11-30","2023-10-26","2025-08-17","2022-12-05","2022-12-05","2022-12-05","2024-11-01","2024-11-01","2025-11-12","2024-11-01","2024-03-21","2025-09-12","2024-11-01","2024-11-01","2024-03-22","2024-11-01","2024-12-20","2025-08-01","2024-10-02","2024-07-12","2023-01-05","2023-01-05","2023-01-05","2024-12-20","2023-10-26","2023-07-11","2023-05-05","2025-10-27","2023-02-07","2025-05-06","2025-01-30","2024-01-04","2023-01-24","2023-02-07","2024-08-06","2024-06-12","2025-05-07","2024-07-12","2024-07-12","2025-01-30","2024-08-21","2024-05-09","2022-10-07","2022-08-18","2022-08-18","2022-08-18"],"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":[["","","ABRYSVO","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}