{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan S Pastore","gend":1,"currentgend":"","add":"777 STEVENS AVE 402","city":"Portland","state":"ME","zip":"04103","dob":"1941-10-17","age":"","mstatus":"","insh":"10000042921","cliId":"","pno":2076158495,"cno":"","email":"rodepast@gmail.com","ename":"","eno":"","pphy":"KATZ, JAMES A","ppno":2077711717,"pcpadd":"144 STATE ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41013776","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"777 STEVENS AVE 402","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04103","pcpfaxno":2077711727,"pcpnpi":1588605604,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8XY5UM6DF52","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C44722","H353134","H43813","D3131","M25511","E785","F3289","I10","L989","T8189XA","T148XXA","C44721","Z98890","I83018","L821","D1801","L738","Z85828","F331","M158","M7741","M79671","M25774","M2041","M1990","L851","M205X1","M205X2","M2011","I83891","H353131","Z23","R600","I83893","Z0101","Z1231","F4310","B029","R197","H538","F330","L578","Z8616","M79602","M546","D492","Z20822","R760","M549","M542","G8929","L720","Z0000","G4700","M25512","R399","L570","M19071","R6889"],"date":["2023-10-30","2025-07-28","2025-07-28","2025-07-28","2023-05-18","2025-09-03","2023-08-14","2025-09-03","2023-03-01","2023-10-30","2025-09-12","2023-10-16","2023-10-30","2023-10-30","2025-07-07","2025-07-07","2025-07-07","2025-07-07","2025-11-19","2024-04-08","2024-04-09","2024-04-09","2024-04-09","2024-04-09","2025-09-03","2024-06-19","2024-06-19","2024-06-19","2024-06-19","2023-10-23","2024-01-23","2025-10-16","2023-10-09","2023-09-25","2025-08-19","2024-12-18","2023-09-05","2024-10-02","2023-04-03","2024-01-03","2023-10-03","2024-07-08","2022-12-08","2025-03-08","2025-03-08","2023-07-10","2022-12-01","2023-09-11","2025-03-08","2025-04-02","2025-04-02","2023-07-10","2022-10-24","2022-10-24","2022-10-24","2022-07-19","2022-07-12","2022-07-11","2022-06-20"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","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":""}]}]}