{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lenora R Farley","gend":1,"currentgend":"","add":"97 COOPER ROAD","city":"Warren","state":"ME","zip":"04864","dob":"1949-11-01","age":"","mstatus":"","insh":"10000041488","cliId":"","pno":2073905807,"cno":"","email":"declined@07222024.com","ename":"","eno":"","pphy":"REDMOND DUROW, AOIFE B","ppno":2073015900,"pcpadd":"Penobscot Bay Family Medicine,15 Anchor Dr Ste 201","pcpcity":"Rockport","pcpstate":"ME","pcpzip":"04856","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 157","madd2":"","madd3":"","mcity":"Warren","mstate":"ME","mzip":"04864","pcpfaxno":2075935359,"pcpnpi":1386665479,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9C59GN1DQ16","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M180","I10","R7303","H40053","H2511","R002","R0789","R55","D489","M7989","Z961","E559","E049","M1811","Z0000","R5383","E039","E871","L570","Z0101","E119","H25013","L578","L814","L719","D1801","M7122","S52352A","S52572A","Z1231","H25813","E785","L918","B009","S52532A","M19041","E063","H2512","M79644","M79645","M79651","E041","M79605","H04123","Z23","D235","Z780","I8002","G8929","S40862A","S52502A","M810","H9201","S52501A","R4182","S52302A","M79622","R739","H608X3","H9319","H6690","J339","R040"],"date":["2025-04-01","2025-07-01","2023-08-31","2025-05-01","2025-06-17","2024-10-11","2024-10-11","2024-10-11","2023-02-03","2025-04-25","2025-08-04","2025-03-04","2025-03-26","2025-08-15","2024-09-04","2023-08-30","2025-07-01","2024-09-10","2025-03-05","2023-01-25","2023-01-25","2024-04-30","2025-03-05","2025-03-05","2025-03-05","2023-02-03","2025-04-18","2024-07-20","2024-07-20","2024-07-18","2025-07-01","2025-09-08","2024-03-05","2025-06-10","2024-10-03","2024-12-31","2023-02-08","2025-07-01","2024-12-31","2024-11-08","2024-11-08","2025-03-26","2025-04-03","2024-04-30","2023-10-31","2023-02-03","2025-02-11","2025-04-18","2024-12-31","2022-11-14","2024-07-20","2025-02-11","2025-04-03","2024-07-26","2025-06-17","2024-08-19","2022-09-27","2022-08-30","2022-04-15","2022-04-15","2022-01-26","2022-01-26","2022-01-26"],"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":[["","","LATANOPROST","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE TRIVALENT 2024-2025","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ADACEL TDAP","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","OLMESARTAN MEDOXOMIL","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","CANDESARTAN CILEXETIL","","","Select","Select",""],["","","CEFDINIR","","","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":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}