{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ramona Maillet","gend":1,"currentgend":"","add":"56 HIGH ST","city":"Sabattus","state":"ME","zip":"04280","dob":"1950-12-04","age":"","mstatus":"","insh":"10000043929","cliId":"","pno":2074858568,"cno":2077546664,"email":"declined@01162025.com","ename":"","eno":"","pphy":"ASSADOLLAHZADEH, MINA","ppno":2077774440,"pcpadd":"St Marys Center for Family Medicine,15 Mollison Way","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"ST MARYS CENTER FOR FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 593","madd2":"","madd3":"","mcity":"Sabattus","mstate":"ME","mzip":"04280","pcpfaxno":2077778197,"pcpnpi":1487068698,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5G85KW3EK84","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D649","E109","I480","I10","I5032","L942","Z0101","Z0000","Z1231","H35371","E119","E785","Z0100","Z9181","I70292","R2689","R296","R531","R1013","I745","Z950","R197","R195","J069","G4733","H02102","Z45018","Z794","R0602","R059","M10041","H04561","H04201","R6889","I3481","I442","M7989","H353132","E103393","H43813","E118","Z7901","I493","R0609","H43391","I110","L03031","G4730","E039","E669","I70262","M341","I739","R0989","H43392","H26491","L905","I2510","I083","H02052","I70212","R29898","R42","E7800","G459","H02103","H01003","J208","B9789","Z20822","Z01812","I471","R2990","I6523","R29818","R6884","I517","I252","R9431","I340","Z01818","I088","I2720","E6601","Z23","I4891","Z1239","E103293","Z961","I483","I491"],"date":["2024-02-23","2025-10-09","2024-09-25","2025-09-24","2025-03-20","2023-08-29","2024-11-18","2025-09-24","2023-05-15","2024-10-08","2022-12-05","2022-12-05","2023-01-31","2025-03-24","2024-10-01","2023-12-06","2023-12-06","2023-12-06","2024-07-08","2024-10-09","2025-11-18","2025-01-09","2025-01-09","2024-03-05","2024-04-30","2023-08-23","2024-01-29","2024-09-04","2024-03-05","2024-03-05","2023-07-11","2023-08-23","2023-06-02","2023-02-10","2025-07-02","2024-09-25","2022-12-04","2024-10-08","2024-10-08","2024-10-08","2023-08-03","2024-03-05","2023-03-24","2023-03-24","2022-12-05","2025-03-20","2022-12-04","2023-08-23","2023-08-23","2023-08-23","2024-10-01","2023-07-20","2025-04-14","2024-09-18","2023-10-10","2023-10-10","2023-07-11","2025-07-02","2025-07-02","2023-12-01","2024-10-09","2023-10-17","2024-09-25","2022-11-09","2022-11-15","2022-10-26","2022-10-26","2022-10-17","2022-10-17","2022-10-17","2022-09-16","2022-09-19","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-06-15","2022-07-29","2022-04-21","2022-04-21","2022-03-17","2022-03-03","2022-03-03","2022-03-03","2021-11-24","2021-11-24","2022-02-04","2022-02-04"],"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":[["","","SPIRONOLACTONE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","INSULIN GLARGINE-YFGN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","TOBRAMYCIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TORSEMIDE","","","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":""}]}]}