{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra J Nadeau","gend":1,"currentgend":"","add":"10 GOFFEE ST","city":"LEWISTON","state":"ME","zip":"04240","dob":"1950-08-01","age":"","mstatus":"","insh":"10000041503","cliId":"","pno":2077130333,"cno":"","email":"declined@11012022.com","ename":"","eno":"","pphy":"KELLY, NICOLE S","ppno":2077958475,"pcpadd":"18 LAURIER ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42404106","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 GOFFEE ST","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":2077958490,"pcpnpi":1114689817,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2AJ4G96GQ78","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K7460","E876","I6529","R188","K529","K7581","F03B0","L7634","K7290","I429","I70209","M79673","M79606","I2510","I739","I70221","I70222","I7092","L539","F03A0","Z0000","R921","I110","I5030","F32A","E039","L0231","I6523","K8020","N189","R600","M79672","F0390","M810","N390","I255","I10","E782","Z029","I6930","M7989","Z515","G309","N6489","N179","Z0389","S93135A","Z09","I509","J189","J811","D696","D631","N289","N644","S91109A","N6325","R109","R7989","Z1231","R531","R0602","L97529","M869","S91309A","I6782","I700","R001","B0052","I5042","Z853","I517","S63287A","N6320","R079","I358","L97509","L03032","N6314","R140","R1013","R059","N170","M8580","M85852","R0902","R5383","Z0101","Z9841","Z9842","F419","L089","D649","S7001XA","L729","Z01818","K090","T148XXA","Z0189","B432"],"date":["2025-08-10","2025-01-06","2023-11-01","2025-09-08","2025-03-03","2025-06-24","2025-07-10","2022-12-13","2025-08-13","2025-04-17","2023-12-06","2023-11-10","2023-10-30","2024-11-19","2023-12-06","2023-10-10","2023-10-26","2023-10-26","2023-09-24","2024-05-23","2023-12-29","2025-04-07","2023-01-10","2023-01-10","2023-01-10","2024-08-05","2023-01-10","2023-11-01","2025-06-04","2024-08-21","2023-12-15","2024-01-31","2025-01-06","2024-08-05","2024-08-18","2023-08-09","2024-08-21","2025-04-17","2023-09-06","2023-09-06","2023-09-24","2025-08-29","2025-06-17","2025-04-07","2024-03-30","2024-02-21","2024-02-21","2024-04-10","2024-02-20","2024-02-20","2024-02-20","2024-04-11","2024-04-11","2024-04-11","2025-03-25","2024-02-15","2025-04-13","2025-03-31","2025-04-17","2024-01-23","2024-02-20","2024-02-20","2024-02-21","2024-02-21","2024-05-15","2024-02-20","2023-10-10","2024-04-21","2023-05-30","2024-02-23","2025-05-01","2025-05-28","2024-01-31","2025-05-01","2024-04-21","2025-05-28","2024-03-20","2024-01-31","2025-04-13","2025-03-25","2025-03-25","2025-03-25","2024-02-20","2024-05-02","2024-01-23","2024-02-20","2024-02-20","2023-03-30","2023-03-30","2023-03-30","2025-08-29","2025-08-29","2024-03-05","2022-11-03","2022-11-17","2022-10-24","2022-11-08","2022-09-29","2022-08-28","2022-08-28"],"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":[["","","FUROSEMIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","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":""}]}]}