{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lynda A White","gend":1,"currentgend":"","add":"161 BUTTERHILL RD","city":"Livermore","state":"ME","zip":"04253","dob":"1963-06-25","age":"","mstatus":"","insh":"10000039307","cliId":"","pno":2078976848,"cno":"","email":"declined@073019.com","ename":"","eno":"","pphy":"ROBERTS, ALEXANDRA","ppno":"","pcpadd":"Family Health Care Associates,190 Stetson Rd","pcpcity":"Auburn","pcpstate":"ME","pcpzip":"04210","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"161 BUTTERHILL RD","madd2":"","madd3":"","mcity":"Livermore","mstate":"ME","mzip":"04253","pcpfaxno":2078345388,"pcpnpi":1033562863,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9RD9UW6AJ40","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0789","G4733","D751","N10","I358","R0781","J449","J189","F17200","R109","E213","M7918","M159","R768","J90","R918","R059","Z87891","F17210","Z0100","R350","I10","J849","D582","E039","G894","Z0000","M25552","J9611","Z8639","M47816","R0902","J069","Z5181","M85852","M160","Z1231","M5136","Z981","M1990","M069","Z79899","J441","R911","J929","I2510","N644","R112","R300","I340","I77810","Z136","J984","J939","J811","L309","Z716","U071","R1011","J432","I509","I517","Z9981","R1013","R634","Z09","R110","R0602","J439","R0600","F17218","M170","M25462","M25562","M25461","M1711","N3946","R3915","R32"],"date":["2024-08-19","2024-03-19","2023-05-23","2024-10-21","2025-06-05","2024-08-19","2025-09-09","2023-04-21","2025-07-18","2024-10-21","2023-10-24","2023-05-25","2023-05-25","2024-11-21","2023-02-02","2024-07-02","2023-02-02","2025-08-20","2025-08-06","2023-02-01","2024-10-21","2023-05-23","2025-09-09","2023-05-26","2024-09-18","2023-09-14","2025-09-11","2024-01-02","2025-09-09","2023-11-29","2024-02-27","2025-07-18","2023-03-27","2023-03-16","2023-12-11","2023-11-07","2023-07-01","2023-11-07","2023-11-07","2023-02-20","2023-11-28","2023-02-22","2025-07-18","2023-10-07","2023-07-15","2023-07-15","2024-08-28","2024-10-14","2024-10-14","2025-06-05","2025-06-05","2025-09-04","2023-10-07","2023-10-07","2023-10-02","2023-02-07","2025-05-20","2023-10-07","2024-08-19","2024-07-02","2023-10-07","2023-10-02","2023-09-28","2024-09-18","2024-09-18","2024-06-26","2024-10-14","2023-10-07","2024-07-02","2025-07-18","2023-05-23","2022-11-09","2022-11-08","2022-11-08","2022-11-08","2022-11-08","2022-09-28","2022-09-28","2022-09-01"],"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":[["","","LEFLUNOMIDE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","ETODOLAC","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ROFLUMILAST","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","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":""}]}]}