{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy M Wing","gend":1,"currentgend":"","add":"1 BRONZE PL","city":"Waterville","state":"ME","zip":"04901","dob":"1949-01-29","age":"","mstatus":"","insh":"10000040710","cliId":"","pno":2078736405,"cno":"","email":"declined@12132024.com","ename":"","eno":"","pphy":"DING, FRANCES","ppno":"","pcpadd":"Oakland Family Medicine,25 First Park Dr","pcpcity":"Oakland","pcpstate":"ME","pcpzip":"04963","pcpcounty":"","pcpid":"","pcpname":"OAKLAND FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1 BRONZE PL","madd2":"","madd3":"","mcity":"Waterville","mstate":"ME","mzip":"04901","pcpfaxno":2079735042,"pcpnpi":1437679495,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XE8Q72DP63","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D509","Z87891","G8929","M1611","I5030","S161XXA","Z794","R29818","M79671","M79672","S3993XA","J90","J9811","L600","E1122","J449","Z7951","R509","J9621","R410","J9622","I4891","Z5189","R109","R4182","R251","Z79899","E1140","J189","R918","E1142","M21621","I509","J811","Z20822","S63502A","M47812","M4802","M25551","J302","G9340","R531","Z5329","R609","R0602","R569","J9620","J441","A419","Z5181","J9601","J9602","N179","R9431","Z4682","E119","K219","Z8719","I110","J810","Y710","Z0000","Z043","Z743","R29898","I130","R600","M79673","M19071","W19XXXA","R059","M19072","I2510","E785","M542","R0600","N1832","R296","M47816","S7001XA","I480","Z01810","S79911A","M47819","J440","M419","I5033","J690","R55","M25569","R739","R400","Z01818","I129","N184","S0990XA","S199XXA","S299XXA","G928","N189","Z0101","Z122","M533","M160","M11232","G43909","I517","D6489","I2720","R5383","L03115","Z09","L539","M7918","M25571","I340","L03031","R519","R0902","M4302","S0003XA","R0989","E8729","J209","J9611","M5416","S79921A","S99921A","D539","M4312","Z1231","S63592A","R42","H6121","R001","E1165","Z7982","J984","Z8709","R040","Z9981","I5020","M8788","G629","M6281","R079","M87851","N1830","R0789","K5730","N261","D500","I5032","I10","M66851","M67853","Z961","H35362","G4700","R6889","J439","Z95818"],"date":["2025-04-22","2025-09-09","2024-10-28","2025-04-24","2025-05-12","2022-12-02","2023-07-26","2025-10-22","2025-03-01","2025-03-01","2025-10-21","2025-10-30","2025-10-22","2025-04-22","2025-08-28","2025-11-10","2025-08-19","2025-10-30","2025-10-30","2025-10-30","2025-10-30","2025-11-04","2023-04-13","2025-10-21","2024-10-11","2023-11-06","2025-03-20","2025-01-27","2025-10-25","2025-10-30","2023-07-26","2024-07-31","2025-04-01","2025-10-27","2022-12-04","2024-09-30","2025-10-14","2025-04-07","2025-09-30","2025-09-09","2024-10-12","2024-10-12","2024-10-13","2025-10-31","2025-10-31","2025-10-25","2022-12-15","2022-12-15","2022-12-15","2025-08-19","2025-10-24","2025-10-22","2025-10-22","2025-11-10","2025-10-23","2024-12-09","2023-03-08","2022-12-23","2025-05-09","2022-12-04","2022-12-04","2025-06-04","2025-10-21","2025-10-21","2025-03-19","2025-03-05","2025-10-29","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-03-01","2025-05-09","2025-05-09","2024-02-29","2022-12-30","2025-08-19","2025-07-02","2025-08-25","2023-05-26","2024-03-07","2025-09-11","2023-12-30","2024-03-04","2025-08-05","2025-06-23","2024-06-19","2022-12-06","2025-02-22","2025-02-22","2025-02-22","2025-02-22","2025-10-06","2024-08-05","2024-08-05","2025-02-22","2025-02-22","2025-02-22","2024-10-12","2025-11-10","2024-11-19","2025-08-18","2025-08-25","2025-08-25","2024-09-30","2023-03-08","2025-11-10","2025-11-10","2023-03-23","2025-11-10","2024-10-21","2024-06-27","2024-11-26","2025-08-25","2024-10-08","2025-10-06","2024-11-27","2023-12-30","2023-12-30","2023-10-09","2023-12-30","2025-11-12","2022-11-28","2025-08-05","2023-10-27","2023-06-08","2023-12-30","2024-10-08","2025-10-09","2023-03-03","2023-09-19","2024-09-30","2025-02-22","2025-04-28","2023-07-05","2023-03-03","2025-09-09","2022-12-11","2022-12-11","2025-07-03","2024-11-12","2025-10-06","2023-02-21","2022-11-08","2022-11-08","2022-11-16","2022-11-15","2022-10-21","2022-10-19","2022-09-28","2022-09-28","2022-08-10","2022-08-31","2022-08-11","2022-08-09","2022-08-09","2022-06-27","2022-06-27","2022-06-29","2022-06-27","2022-06-22","2022-06-15"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANC DEV","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","ACETAZOLAMIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","RIZATRIPTAN","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","ONETOUCH DELICA","","","Select","Select",""],["","","CEPHALEXIN","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}