{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth F Kane","gend":1,"currentgend":"","add":"75 CIVIC CENTER DR APT 102","city":"AUGUSTA","state":"ME","zip":"04330","dob":"1940-05-16","age":"","mstatus":"","insh":"10000040973","cliId":"","pno":2072136553,"cno":2074465753,"email":"declined@042925.com","ename":"","eno":"","pphy":"STRICKLAND, DONALD J","ppno":2076238434,"pcpadd":"\tKennebec Internal Medicine,9 Glenridge Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"KENNEBEC INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"75 CIVIC CENTER DR APT 102","madd2":"","madd3":"","mcity":"AUGUSTA","mstate":"ME","mzip":"04330","pcpfaxno":2076214370,"pcpnpi":1861431819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9CM6DX6NW45","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I8000","Z7901","M2550","E8342","M353","R609","I10","Z1231","S0990XA","M160","M25559","M47816","M4187","M5136","M5450","M47812","M4802","M5030","Z86718","Z23","M170","I82409","D509","R600","R0602","H2513","H2512","Z961","H04123","H16143","R5383","R634","M19011","H2511","K2970","Z0100","M50321","J3489","R509","J329","H5703","M7910","R109","Z043","G319","R9089","M25511","M549","K279","L820","H532","M9903","M9904","M9902","K219","F419","Z0000","C44719","R030","R3589","D649","D485","L821","N1830","D689"],"date":["2025-10-23","2025-10-23","2023-06-22","2025-05-22","2024-08-21","2024-01-24","2025-09-30","2024-06-05","2023-11-06","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2023-04-19","2025-10-23","2023-09-28","2023-09-28","2024-02-21","2024-06-11","2024-06-11","2024-02-01","2024-02-15","2024-02-02","2025-03-13","2025-03-13","2024-05-30","2023-06-22","2024-09-11","2024-02-01","2025-05-21","2025-03-13","2023-05-10","2025-04-10","2025-04-10","2025-04-10","2024-02-15","2024-08-21","2025-01-22","2023-11-06","2023-11-06","2023-11-06","2024-09-11","2023-05-10","2023-05-10","2023-01-04","2024-09-25","2023-05-05","2023-05-05","2023-05-05","2023-07-20","2023-07-20","2025-03-19","2024-10-21","2025-04-03","2024-05-30","2023-06-22","2024-07-23","2024-07-23","2022-10-12","2022-10-12"],"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":[["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","CEQUA","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}