{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dana R Pushard","gend":0,"currentgend":"","add":"205 SHAKER RD","city":"Gray","state":"ME","zip":"04039","dob":"1967-07-12","age":"","mstatus":"","insh":"10000042897","cliId":"","pno":2072127821,"cno":"","email":"drpx4@fairpoint.net","ename":"","eno":"","pphy":"SALKO, DAVID L","ppno":2077986200,"pcpadd":"4 HORTON PL,STE. 101","pcpcity":"TOPSHAM","pcpstate":"ME","pcpzip":"40861747","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"205 SHAKER RD","madd2":"","madd3":"","mcity":"Gray","mstate":"ME","mzip":"04039","pcpfaxno":2077986290,"pcpnpi":1659338879,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1KC6GY1YU84","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T847XXD","M069","N179","I10","E119","I2510","E162","M25559","F419","M19041","M19042","Z98890","R109","R52","M5124","M5134","M48061","R9431","R609","E785","Z1211","D124","K5730","Z860100","G629","T84090A","Z471","I340","T8451XA","B957","I429","I517","M4800","M5136","S72002A","Z01818","R600","S73004A","S32592A","M25542","Z96641","M5104","T84091A","T8484XA","E1122","E1140","K3184","S32502A","S32018A","S32028A","S32038A","M5450","Z96649","Z23","S32009A","R7401","Z7689","M25552","Z96642","M542","S299XXA","R0781","S0990XA","E1142","T8450XA","R590","A419","M25569","M5137","Z0000","R000","G5692","M65322","K760","I5189","W19XXXA","R079","K922","R7989","D631","I214","I361","I129","D649","R160","R591","S80861A","R509","I5021","K7200","R102","Z96643","B351","J323","J320","N1832","E118","N1830","J811","Z043","Z6836","M5116","M4726","E876","R809","R0609","Z4789","T84020A","A6920","Z09","M25551","F1290","M549","R059","M79642","F1021","Z794","R001","F4310","F1011","I2584","Z9861","E7801"],"date":["2025-03-11","2025-06-18","2025-07-03","2025-02-12","2025-11-11","2025-11-11","2025-07-01","2024-09-05","2025-03-05","2025-06-18","2025-06-18","2024-08-14","2024-09-23","2025-02-12","2025-02-20","2025-02-20","2025-11-12","2023-08-21","2023-12-27","2024-04-17","2025-04-28","2025-04-28","2025-04-28","2025-04-28","2023-02-13","2024-07-29","2024-09-18","2025-03-10","2024-12-09","2024-10-04","2025-05-28","2023-09-05","2025-01-03","2023-11-21","2025-07-16","2024-07-18","2024-10-06","2024-07-04","2025-07-15","2025-06-18","2025-01-03","2025-02-20","2024-03-11","2024-03-11","2025-04-01","2024-09-10","2024-03-11","2025-07-15","2025-07-15","2025-07-15","2025-07-15","2025-11-12","2024-09-06","2024-02-14","2025-07-16","2025-07-16","2024-10-28","2025-07-01","2025-07-01","2025-10-30","2025-07-01","2025-07-01","2025-07-01","2024-09-23","2024-09-23","2024-10-10","2024-09-26","2023-08-25","2023-12-27","2023-02-28","2024-10-07","2023-01-03","2023-01-03","2024-10-05","2023-10-09","2025-07-01","2024-10-08","2024-10-07","2025-04-09","2024-09-10","2024-10-14","2024-10-08","2025-04-01","2024-10-11","2024-10-08","2024-10-07","2023-07-25","2024-10-07","2024-10-07","2024-10-07","2025-07-15","2025-07-15","2025-04-09","2024-10-15","2024-10-15","2025-04-01","2023-02-28","2025-02-12","2024-10-12","2025-10-30","2023-02-28","2024-05-22","2024-05-22","2025-02-03","2024-04-17","2025-04-21","2024-09-26","2024-07-05","2023-08-21","2023-08-21","2025-01-03","2025-04-21","2023-09-19","2024-09-23","2022-11-04","2022-10-27","2022-10-31","2022-11-03","2022-10-13","2022-10-13","2022-08-25","2022-08-01","2022-08-01"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","NOVOLIN N FLEXPEN","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","HUMULIN N KWIKPEN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","HUMULIN N","","","Select","Select",""],["","","FREESTYLE TEST STRIPS","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","VICTOZA 3-PAK","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUARIX TRIVALENT 2024-2025","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","NOVOLIN 70-30","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"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":""}]}]}