{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carol J Young","gend":1,"currentgend":"","add":"263 MAIN ST","city":"Cumberland","state":"ME","zip":"04021","dob":"1950-06-19","age":"","mstatus":"","insh":"10000042291","cliId":"","pno":"","cno":2072513178,"email":"swampjohns@yahoo.com","ename":"","eno":"","pphy":"PANOZZO, SHASHI T","ppno":2078469013,"pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 734","madd2":"","madd3":"","mcity":"CUMBERLAND","mstate":"ME","mzip":"04021","pcpfaxno":2075238586,"pcpnpi":1255301701,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8CM6CP3JE81","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R6889","E213","M8580","E042","M5416","R531","H8111","M532X6","Z4789","D122","D124","K5730","E119","N1831","M76821","M79671","M48061","M6281","S8990XA","G4733","Z23","Z0001","E785","R194","M8588","D513","D509","K635","N289","R7989","N1832","D631","M48062","E214","M4316","M5124","D123","K648","Z980","J40","H903","M26609","M4310","M9953","M5136","R7303","Z1211","K621","M79604","H8110","R059","J205","I10","N2889","M19071","M25552","Z713","E1129","S76302D","S83241A","Z9989","R739","D638","I129","E041","R7309","Z981","I700","L820","D225","L821","L578","S8991XA","H40053","H04123","M4726","J069","Z0000","S8391XA","Z8639","M1711","Z1231","M94261","S83231A","R21","E049","E8352","A6000","R42","M5450","S86812A","M25561","N281","R946","M2011","M2021","M4727","D1801","H01133","H01136","M7751","D1803","L720","L853","R002","M940","S0300XD","G5602","G4730","E0590","H524","K828","E278"],"date":["2023-04-03","2025-08-28","2025-09-15","2025-08-11","2025-03-26","2023-09-21","2023-09-21","2024-08-07","2025-07-17","2025-08-25","2024-12-12","2025-08-25","2025-11-03","2025-08-27","2024-07-12","2024-06-19","2025-03-26","2024-05-10","2023-06-01","2025-11-13","2024-10-29","2024-10-29","2025-11-03","2024-11-15","2024-10-30","2025-05-08","2025-11-03","2023-08-01","2025-07-21","2025-08-28","2025-02-19","2025-02-19","2024-01-09","2024-06-04","2025-03-26","2024-09-10","2025-02-10","2025-02-10","2025-02-10","2023-12-13","2023-03-16","2023-03-16","2024-03-12","2024-03-12","2024-03-12","2025-05-13","2025-08-25","2025-08-25","2025-04-14","2023-02-22","2023-12-13","2023-12-05","2025-08-27","2025-08-27","2024-06-19","2025-08-29","2024-12-19","2024-12-19","2023-07-25","2024-06-20","2023-05-15","2023-04-05","2023-04-05","2024-10-22","2025-11-03","2023-04-05","2025-05-01","2025-05-01","2024-05-28","2024-05-28","2024-05-28","2024-05-28","2024-06-14","2025-09-04","2023-08-10","2023-09-18","2023-12-02","2023-10-13","2024-06-10","2025-11-03","2024-06-14","2024-04-16","2024-07-15","2024-07-15","2025-07-03","2023-04-12","2023-04-12","2024-01-24","2023-03-21","2025-03-26","2023-06-16","2024-06-10","2023-11-15","2023-01-24","2022-12-02","2022-12-02","2023-09-05","2022-10-20","2022-10-20","2022-10-20","2022-10-11","2022-09-07","2022-06-02","2022-06-02","2022-05-31","2022-05-13","2022-04-04","2022-04-04","2022-04-04","2021-11-10","2021-11-29","2021-12-06","2021-12-09"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","MINOXIDIL","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","METHIMAZOLE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","PEG3350-SOD SUL-NACL-KCL-ASB-C","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FREESTYLE LITE METER","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","ONETOUCH VERIO REFLECT METER","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"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":""}]}]}