{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gail E Seabury","gend":1,"currentgend":"","add":"362 E MAIN ST","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1950-11-22","age":"","mstatus":"","insh":"10000044472","cliId":"","pno":2078464495,"cno":"","email":"BFLOGAL@HOTMAIL.COM","ename":"","eno":"","pphy":"PATCH, JEFFREY S","ppno":2078469013,"pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"362 E MAIN ST","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2078741483,"pcpnpi":1720067317,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6YP4QH4AC61","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G35","S72001A","W19XXXA","E11610","Z23","R339","N319","R2681","R2689","R262","M6281","S22009A","H5213","H532","H52223","H5022","R300","S22050D","S12290D","S12100D","M62838","E559","E538","G4733","N390","S76212A","R8290","G4730","E039","F32A","M1612","N3000","S12101A","E089","E119","S72009A","G35A","G8220","E1165","R112","L400","D692","L821","L720","E871","G4700","E785","M810","Z98890","S12101D","S12200D","S060X0D","M533","S72001D","S12100S","E1136","R32","M80051D","M25551","Z9359","R490","N312","M546","S12100A","R1032","E1169","Z0000","G35C0","R338","M25552","H2513","H33303","T148XXA","S22050A","Z471","Z96641","G9389","H8113","M80851A","H903","L298","F4323","G459","M4854XD","E113293","F330","R531","R5381","H8112","A000","M9903","M9904","M9905","M79651","S12120D","N3289","K7689","N281","Z87891","S7291XA","N898","Z435","Z960","R102","W1811XA","M80851D","S12200A","S22059A","M47814","R410","Z8781","Z515","R1110","R079","Z0101","Z20822","E1121","G35D","L8942","R269","M2450","R6889","L508","S22000A","Z1231","W108XXA","E1142","L570","L282","A419","Z743","T07XXXA","R0789","M549","M542","S22058D","S0990XA","S199XXA","S3993XA","S3991XA","S299XXA","R42","R202","M65832","M25542","M5450","M5137","G8929","M5440","M654","L299","F325","H9319","G5602","R293","M67432","Z9189","M79642","H8110","M25532","M353","M7540","M170","M8588","L309","R238","H4911","M940","M47812"],"date":["2025-09-28","2023-01-29","2023-01-27","2023-01-27","2025-07-28","2025-09-24","2025-09-24","2024-06-26","2025-01-15","2023-08-28","2023-08-28","2022-11-30","2023-07-12","2023-07-12","2023-07-12","2023-07-12","2025-01-22","2025-11-14","2025-11-06","2025-11-06","2025-06-19","2025-02-18","2025-02-18","2023-07-18","2025-08-29","2025-04-18","2024-07-11","2025-08-13","2025-08-13","2025-04-29","2025-04-18","2023-01-31","2023-01-31","2023-01-31","2025-04-21","2023-02-08","2025-11-06","2025-11-18","2025-10-31","2025-06-09","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2023-03-29","2022-12-09","2025-08-13","2024-08-06","2025-04-29","2023-03-17","2023-03-17","2023-03-17","2025-07-24","2023-03-29","2023-02-08","2025-11-03","2025-11-14","2023-02-03","2025-10-22","2025-09-03","2025-09-03","2023-10-27","2023-01-11","2023-02-06","2025-03-31","2025-11-05","2025-09-26","2025-11-18","2025-08-13","2025-04-18","2023-03-28","2023-03-28","2024-09-25","2022-12-19","2023-03-06","2025-10-22","2023-06-16","2023-07-31","2023-01-27","2023-05-24","2023-12-14","2024-05-21","2023-01-27","2023-06-16","2024-05-03","2023-06-27","2025-06-16","2025-06-07","2023-06-22","2025-08-23","2023-02-07","2023-02-07","2023-02-07","2023-02-07","2023-03-08","2025-08-13","2025-06-08","2025-06-08","2025-08-13","2023-01-31","2024-04-17","2025-08-14","2025-08-14","2023-01-27","2023-01-27","2023-01-31","2023-01-11","2023-01-11","2023-01-11","2023-03-22","2023-03-16","2025-11-10","2025-06-08","2025-06-08","2023-09-06","2023-05-03","2025-11-05","2025-11-05","2025-11-05","2025-11-18","2025-11-18","2023-12-14","2023-09-23","2022-11-30","2024-01-22","2022-11-30","2023-05-24","2024-06-17","2024-06-17","2025-06-16","2025-06-16","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2022-11-23","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2022-10-19","2022-10-14","2022-10-14","2022-10-14","2022-08-11","2022-08-11","2022-08-11","2022-08-25","2022-08-01","2022-07-20","2022-07-18","2022-07-18","2022-06-27","2022-07-06","2022-05-24","2022-04-28","2022-04-15","2022-04-14","2022-04-15","2022-03-22","2022-02-28","2022-02-28","2021-11-18","2021-11-22","2021-11-22","2021-12-10","2021-12-20","2022-01-28"],"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":[["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","BUPRENORPHINE","","","Select","Select",""],["","","MORPHINE SULFATE ER","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","SELENIUM SULFIDE","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","METHENAMINE HIPPURATE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","AUBAGIO","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE OIL","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FOSFOMYCIN TROMETHAMINE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","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":""}]}]}