{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beulah E Evans","gend":1,"currentgend":"","add":"20 WILLOW ST APT 204","city":"AUGUSTA","state":"ME","zip":"04330","dob":"1944-07-06","age":"","mstatus":"","insh":"10000042840","cliId":"","pno":2074413994,"cno":"","email":"declined@092325.com","ename":"","eno":"","pphy":"STRICKLAND, DONALD J","ppno":2076238434,"pcpadd":"\tKennebec Internal Medicine,9 Glenridge Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"KENNEBEC INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 WILLOW ST APT 204","madd2":"","madd3":"","mcity":"AUGUSTA","mstate":"ME","mzip":"04330","pcpfaxno":2076214370,"pcpnpi":1861431819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7Y76KA6PK83","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G319","Z48812","I5032","L570","I422","E1159","E1165","D485","R079","R748","Z0100","H04122","C44519","I080","Z95818","M47815","M79605","R29898","Z950","I10","Z794","I509","I959","D61818","L814","L821","D225","Z7189","R918","I2510","R053","M549","D649","N1832","D696","D469","M069","R945","R600","G250","R059","E119","I447","I459","L905","R7989","I442","R718","J90","R350","K219","R4182","M7910","H00012","R9431","D539","M19011","M19012","I3139","I480","R0602","L820","R5383","M79601","L89312","I351","L2084","N1831","R7401","N179","D509","R110","L2089","Z08","Z85828","R935","K5730","R932","R1032","M25531","Z006","R112","M25562","I517","M5450","M542","R58","R5381","J22","J3489","S0990XA","N289","R1310","K529","R55","M79604","M62838","R0600","Z1152","R0609","M059","T394X1A","Z7952","K55069","J209","I4891","M2550","M7989","M79641","M19041","I499","C9110","R531","R21","R109","Z9089","L308","N261","K760","Z79899","M1811","M19031","L538","L298","M25521","M25421","Z85820","U071","E785","J9819","D229","R404","R1084","R7309","R1110","R197","M1990","Z23","B372","H00019","R2241"],"date":["2024-01-13","2024-05-02","2025-09-09","2025-07-08","2025-10-28","2025-11-18","2025-03-17","2024-06-21","2025-07-09","2024-07-22","2025-03-18","2025-03-18","2023-11-02","2024-03-29","2024-03-29","2024-02-26","2024-02-26","2024-02-26","2025-11-12","2025-11-18","2025-11-18","2025-10-10","2024-03-04","2024-03-04","2024-06-21","2024-06-21","2024-06-21","2024-06-21","2025-06-04","2023-06-26","2023-06-26","2024-02-26","2025-10-23","2024-08-20","2024-03-04","2025-09-10","2024-07-31","2024-03-04","2024-03-04","2024-08-20","2024-02-22","2025-11-06","2025-08-11","2024-03-29","2023-11-02","2025-09-10","2025-02-11","2024-01-12","2025-07-09","2025-02-27","2024-03-29","2024-03-29","2025-08-06","2025-06-02","2025-10-23","2024-03-04","2025-10-17","2025-10-17","2025-06-04","2025-06-04","2024-04-05","2024-06-21","2025-10-23","2023-03-06","2024-02-28","2024-03-29","2023-04-17","2025-06-02","2024-04-14","2024-02-29","2025-05-22","2025-11-12","2024-04-24","2024-04-24","2024-04-24","2024-01-11","2024-01-11","2024-01-11","2024-01-11","2023-03-06","2025-06-13","2022-12-13","2024-04-05","2025-06-04","2024-04-11","2023-07-13","2024-04-28","2024-04-28","2023-01-02","2023-01-02","2024-03-27","2023-02-03","2023-07-06","2024-01-06","2024-03-28","2025-10-23","2025-07-09","2025-06-04","2024-04-06","2025-06-11","2024-01-29","2024-01-29","2024-01-29","2024-02-05","2022-12-08","2025-07-09","2025-07-21","2023-03-06","2023-03-06","2023-03-06","2024-09-25","2024-01-31","2024-01-06","2024-01-08","2025-01-06","2024-01-04","2024-01-12","2025-01-06","2025-01-06","2025-05-13","2023-03-06","2023-03-06","2023-04-27","2023-04-27","2023-03-06","2023-03-06","2024-01-12","2023-01-03","2025-02-11","2025-06-04","2023-10-19","2024-01-04","2024-01-10","2024-02-21","2022-11-15","2022-11-15","2022-10-20","2022-10-04","2022-09-09","2022-09-09","2022-08-24"],"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":[["","","ONDANSETRON ODT","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","XDEMVY","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","DESONIDE","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","LEUCOVORIN CALCIUM","","","Select","Select",""],["","","ATOVAQUONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FREESTYLE LITE METER","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","NOVOLOG MIX 70-30 FLEXPEN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","DEXCOM G6 RECEIVER","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CONTOUR NEXT TEST STRIP","","","Select","Select",""],["","","INSULIN ASPART PROT MIX 70-30","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}