{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane E Poulin","gend":1,"currentgend":"","add":"40 COBURN AVE","city":"SKOWHEGAN","state":"ME","zip":"04976","dob":"1950-04-03","age":"","mstatus":"","insh":"10000040479","cliId":"","pno":2073139650,"cno":"","email":"padpou@yahoo.com","ename":"","eno":"","pphy":"Obrien, Samantha L","ppno":"","pcpadd":"SOMERSET PRIMARY CARE,62 MAIN ST","pcpcity":"SKOWHEGAN","pcpstate":"ME","pcpzip":"04976","pcpcounty":"","pcpid":"","pcpname":"SOMERSET PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"40 COBURN AVE","madd2":"","madd3":"","mcity":"SKOWHEGAN","mstate":"ME","mzip":"04976","pcpfaxno":"","pcpnpi":1689393571,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8H11NP4GX98","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H02403","H02831","H02834","H53453","Z1231","S61111A","I83813","D2339","I872","I83893","M5431","Z0101","H35373","H2513","H04123","M170","M9902","M546","M9903","M5450","Z48812","Z85828","R2230","M25562","M25561","M5126","M4186","M4316","M47816","I8390","R6889","Z0000","M25462","M25461","M810","H524","H52223","H5203","H5213","D225","H2511","H2512","H5703","L570","L820","I8393","I781","Z1283","D2220","L821","G8929","M549","D229","D1801","M533","Z48810","B351","M1710","M1712","X58XXXA","Z01818","R21","L989","L814"],"date":["2022-11-11","2022-11-11","2022-11-11","2022-11-11","2024-04-15","2022-09-06","2023-12-28","2022-11-11","2024-05-15","2024-01-11","2025-05-29","2025-02-21","2025-02-21","2025-02-21","2025-02-21","2025-05-06","2025-04-21","2025-04-21","2025-04-21","2025-06-27","2024-05-06","2023-06-13","2022-09-06","2023-04-13","2024-08-12","2023-04-12","2023-04-12","2023-04-12","2023-04-12","2024-03-01","2023-03-14","2025-01-08","2023-01-03","2023-04-13","2024-06-27","2023-02-09","2023-02-09","2023-02-09","2023-02-09","2025-04-15","2025-05-13","2025-05-13","2025-05-13","2025-04-15","2025-04-15","2023-03-28","2023-03-28","2024-04-18","2023-04-11","2024-04-18","2023-04-13","2025-01-09","2024-04-18","2024-04-18","2024-03-26","2022-11-17","2022-09-27","2024-07-02","2024-10-10","2024-10-10","2022-11-03","2022-06-25","2022-07-06","2022-06-21"],"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":[["","","CELECOXIB","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}