{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leslee A Stone","gend":1,"currentgend":"","add":"1711 AVENUE RD","city":"EXETER","state":"ME","zip":"04435","dob":"1950-10-01","age":"","mstatus":"","insh":"10000045091","cliId":"","pno":2073792952,"cno":"","email":"LESLEESTONE@YAHOO.COM","ename":"","eno":"","pphy":"GEOGHEGAN, HAILEY E","ppno":2079073300,"pcpadd":"St Joseph Internal Medicine,900 Broadway Bldg 5","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1711 AVENUE RD","madd2":"","madd3":"","mcity":"EXETER","mstate":"ME","mzip":"04435","pcpfaxno":2079071923,"pcpnpi":1003586025,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4XV1KN2TM94","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E039","M1612","R6889","M85852","Z471","M24152","I491","E119","Z0000","Z0101","H5213","G588","M65312","M7072","M9901","M542","M9902","M9903","Z1231","Z780","M65311","Z1159","Z96651","T84032D","M79671","L851","M25552","R262","H179","Z961","Z9849","T8484XD","T84032A","Z01812","M1811","M5136","Z96642","H524","Z96653","H43813","T84062A","G548","E782","M7918","D225","L814","L821","Z7189","R000","M48061","M5127","M47817"],"date":["2025-05-23","2025-04-01","2023-11-27","2023-06-05","2025-10-31","2025-02-08","2025-07-29","2025-05-29","2025-05-29","2025-05-15","2023-05-10","2024-10-08","2024-01-30","2025-02-24","2025-11-07","2025-11-07","2025-11-07","2025-11-07","2025-09-02","2025-09-02","2024-03-13","2023-08-03","2025-10-21","2025-07-31","2023-06-13","2023-06-13","2025-05-21","2024-02-22","2022-11-30","2022-11-30","2022-11-30","2025-07-29","2025-07-29","2025-06-13","2024-06-28","2024-03-30","2025-05-21","2025-05-15","2025-10-31","2025-01-22","2024-09-18","2025-01-23","2023-08-03","2024-05-06","2024-06-24","2024-06-24","2024-06-24","2024-06-24","2025-04-04","2024-03-30","2024-03-30","2024-03-30"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","NABUMETONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LIOTHYRONINE SODIUM","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","BETAMETHASONE VALERATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}