{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda M Covell","gend":1,"currentgend":"","add":"75 HIGHLAND RD","city":"BRIDGTON","state":"ME","zip":"04009","dob":"1950-05-11","age":"","mstatus":"","insh":"10000041474","cliId":"","pno":2076475712,"cno":"","email":"LCOVELL@roadrunner.com","ename":"","eno":"","pphy":"WRIGHT, ERINN H","ppno":2078038888,"pcpadd":"Joyful Balance Holistic Healing,171 Portland Rd Ste 4","pcpcity":"Bridgton","pcpstate":"ME","pcpzip":"04009","pcpcounty":"","pcpid":"","pcpname":"JOYFUL BALANCE HOLISTIC HEALING","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"75 HIGHLAND RD","madd2":"","madd3":"","mcity":"BRIDGTON","mstate":"ME","mzip":"04009","pcpfaxno":2076556188,"pcpnpi":1003887514,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2UT8M77VU40","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","M75101","K219","F418","M170","I6329","R6889","M25561","L570","T148XXA","L089","H6121","M179","S4991XA","I639","R5381","I69993","F419","E871","K5909","M25511","M19011","L84","R262","M79674","E1142","I6523","R471","M6281","G9389","Z1211","I6782","R29818","Z1231","G518","E785","R270","E559","Z0000","Z471","Z96611","M1712","M19042","M1812","K5900","M25569","H8101","Z0101","H35363","H43811","I69354","Z0389","H47323","Z136"],"date":["2025-08-27","2025-02-10","2025-02-10","2025-08-27","2025-07-14","2023-02-09","2023-10-13","2025-08-15","2025-06-16","2025-06-16","2025-06-16","2025-06-25","2025-08-08","2023-01-28","2023-05-16","2023-02-24","2023-02-24","2023-02-27","2023-04-21","2023-04-21","2023-01-28","2025-02-19","2023-07-13","2023-07-13","2023-07-13","2023-07-13","2023-02-09","2023-02-09","2023-05-03","2023-02-09","2025-06-12","2023-02-09","2023-02-09","2023-02-08","2023-03-24","2025-06-25","2023-02-12","2022-12-16","2025-05-19","2025-07-07","2025-07-07","2023-09-21","2023-01-11","2023-01-11","2025-08-27","2025-07-14","2023-03-24","2025-02-18","2025-02-18","2025-02-18","2023-02-14","2023-02-09","2023-07-20","2022-11-17"],"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":[["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","DILT-XR","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","DILTIAZEM 24HR ER (LA)","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CAPVAXIVE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","VALSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO 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":""}]}]}