{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lorraine D Clavette","gend":1,"currentgend":"","add":"325 WEBSTER ST","city":"LEWISTON","state":"ME","zip":"04240","dob":"1944-04-14","age":"","mstatus":"","insh":"10000038796","cliId":"","pno":2077546090,"cno":"","email":"dionclavette1944@gmail.com","ename":"","eno":"","pphy":"THORP, LYDIA A","ppno":2075243501,"pcpadd":"180 CHURCH HILL RD STE 1,","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"325 WEBSTER ST","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":2075242093,"pcpnpi":1801875018,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5X82C93KC28","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","M9903","M5432","M9904","M9905","R911","I2510","Z780","H539","D649","R8281","N8111","K529","I10","I480","I471","R9431","E785","N3000","R059","E8351","Z0101","H16223","J329","E538","R918","R002","Z1231","R058","R252","N393","M810","I6782","R9089","R42","G319","R6889","E876","K2970","K7401","R7989","J449","K219","Z0000","R748","Z800","Z7901","R945","R109","I77810","M549","S39012A","M47816","M4316","M546","M47814","M5134","M40209"],"date":["2025-05-21","2024-08-07","2024-08-07","2024-08-07","2024-08-07","2023-06-26","2023-06-26","2025-05-22","2023-01-24","2025-09-20","2023-08-07","2023-08-07","2023-07-03","2024-09-24","2023-03-08","2023-03-08","2023-03-08","2025-04-08","2023-07-19","2023-06-20","2023-11-30","2024-09-24","2024-09-24","2023-04-27","2023-03-27","2023-04-27","2023-02-15","2025-05-22","2023-10-23","2025-09-09","2023-08-07","2025-05-22","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2023-02-20","2023-01-19","2024-05-02","2023-01-10","2023-01-10","2023-05-11","2023-05-11","2025-03-26","2022-10-17","2022-10-14","2022-09-30","2022-09-12","2022-09-23","2022-08-25","2022-08-29","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-30"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","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":""}]}]}