{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan W Ingalls","gend":1,"currentgend":"","add":"15 CITY VIEW AVE","city":"Portland","state":"ME","zip":"04109","dob":"1950-02-05","age":"","mstatus":"","insh":"10000045184","cliId":"","pno":2072324299,"cno":"","email":"SINGALLS@MAINE.RR.COM","ename":"","eno":"","pphy":"EDWARDS, CHRISTINA S","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 700","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 7602","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04112","pcpfaxno":2075238597,"pcpnpi":1326334335,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7WV3FW4KQ97","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H5712","Z87891","M160","Z0100","M25551","M48061","H259","R1031","Z23","M170","H18832","M1711","Z0001","M25552","Z471","L989","H2511","M8589","M51369","M47816","M51370","D259","G8929","R1030","M5450","Z1231","H2512","Z96651","M2042","M79672","L84","E7800","L570","L718","L578","R7309","H2513","J069","T23201A","D128","Z1211","K5730","M8588","H35372","H43812","H04123","R1032","R6889","H538","T23251D","A000","M179","G8918","R4182","H53142","M66851","M66852","Z0000","Z13220","Z01812","G4762","Z01818","Z9049","K4020","M1990","K469","H00019"],"date":["2024-09-06","2024-10-26","2025-01-06","2025-03-12","2025-02-20","2025-10-28","2024-06-11","2025-05-30","2025-10-22","2024-05-22","2024-09-06","2024-10-26","2025-01-20","2025-02-20","2025-06-12","2023-04-11","2024-06-25","2025-01-20","2025-10-07","2025-10-07","2025-03-19","2023-08-09","2025-07-13","2025-07-13","2025-03-19","2025-05-12","2024-06-11","2025-06-12","2025-02-03","2025-02-03","2025-02-03","2025-01-20","2023-05-05","2023-05-05","2023-05-05","2025-01-20","2024-07-25","2022-12-31","2025-11-02","2024-10-11","2024-10-11","2024-10-11","2024-01-19","2024-01-16","2024-01-16","2024-01-16","2025-05-30","2023-07-13","2023-12-11","2025-11-12","2024-10-28","2024-10-25","2024-10-26","2024-10-25","2024-09-04","2025-04-25","2025-04-25","2023-11-07","2023-11-07","2024-08-22","2024-08-22","2024-08-22","2022-11-19","2022-10-05","2022-10-05","2022-05-23","2022-01-26"],"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":[["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ERYTHROMYCIN","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}