{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anna D Kimball","gend":1,"currentgend":"","add":"29 SCHOOL STREET","city":"Lewiston","state":"ME","zip":"04240","dob":"1949-01-28","age":"","mstatus":"","insh":"10000041451","cliId":"","pno":2075763295,"cno":2072401543,"email":"dakinmaine@live.com","ename":"","eno":"","pphy":"FERGUSON, CAROLYN A","ppno":"","pcpadd":"\tCentral Maine Family Medicine,12 High St Ste 302","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"29 SCHOOL STREET","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":4027292102,"pcpnpi":1942653415,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7UV1F72PQ17","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J449","Z148","J310","Z09","Z87891","J188","Z5181","E8801","M810","G546","Z89611","R2689","Z448","C419","J441","G5613","Z0000","R918","I10","J189","R0602","R051","Z20822","S78011A","H04123","Z961","H524","Z7952"],"date":["2025-06-03","2025-06-03","2025-06-03","2025-06-03","2024-10-25","2023-12-04","2023-04-14","2024-09-06","2023-11-09","2024-12-17","2024-12-20","2024-12-17","2024-12-17","2023-08-10","2025-01-30","2024-10-10","2024-05-16","2025-01-30","2023-11-06","2025-01-30","2025-01-30","2023-12-04","2023-12-04","2023-08-10","2022-09-19","2022-09-19","2022-09-19","2022-09-29"],"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":[["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","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":""}]}]}