{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nora J Doucette","gend":1,"currentgend":"","add":"58 AUTUMN LANE","city":"LEWISTON","state":"ME","zip":"04240","dob":"1950-12-04","age":"","mstatus":"","insh":"10000045376","cliId":"","pno":2072400828,"cno":"","email":"NORA.DOUCETTE@ICLOUD.COM","ename":"","eno":"","pphy":"TAN, EDWIN V","ppno":2073303950,"pcpadd":"PO BOX 7291,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"AUBURN MEDICAL ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"58 AUTUMN LANE","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":2073303955,"pcpnpi":1629074240,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5WY5PW3QR71","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S42291P","E1142","S42291D","E1165","E119","M25551","B351","M79675","M79674","Z4800","R3989","Z0000","M25512","R569","I480","D649","Z794","E782","S42291A","I10","E1121","I872","I87393","R600","I87323","M25611","R52","I214","I87313","L97819","S42292A","M19012","R109","R809","I350","S43401A","R002","D509","I6523","S42211A","S42251A","E7849","T148XXA","I4891","G8929","Z9181","F17200","D508","N281","M5450","L84","M67472","E6601","F1199","Z01818","S42202A","S42252A","S42292D","E785","E103293","Z0101","H04123","H25813","I083","S4991XA","I252","I447","I2510","S0990XA","S81802A","K219","M51370","M47816","M4316","W010XXA","Y92009","R079","R918","I3481","K769","Z20822","I361","E1149","J449"],"date":["2025-07-15","2025-09-19","2025-07-15","2024-08-16","2024-03-25","2025-06-06","2025-09-19","2025-03-12","2025-03-12","2025-11-17","2024-04-23","2025-02-11","2025-10-23","2025-07-28","2025-06-10","2024-04-19","2025-09-05","2023-11-01","2025-05-02","2025-09-05","2025-09-19","2025-03-21","2025-03-21","2025-03-21","2025-03-14","2025-07-15","2025-06-04","2023-05-03","2025-02-18","2025-02-18","2025-10-30","2025-03-22","2024-03-08","2024-04-23","2025-07-22","2025-10-23","2022-12-15","2025-06-10","2025-02-11","2025-03-28","2025-03-22","2023-06-23","2023-06-23","2022-11-24","2025-03-11","2025-07-28","2022-11-24","2025-03-08","2024-04-23","2025-03-11","2023-10-31","2023-10-31","2023-10-20","2023-10-20","2025-10-28","2025-10-28","2025-10-28","2025-11-20","2023-02-03","2024-08-28","2024-08-28","2024-08-28","2024-08-28","2025-07-22","2025-03-22","2025-06-10","2025-06-10","2022-12-09","2025-10-23","2025-02-11","2024-04-19","2025-03-14","2025-03-14","2025-03-14","2025-10-23","2025-10-23","2022-11-23","2022-11-23","2022-11-23","2022-11-23","2022-11-23","2022-11-25","2022-01-24","2022-01-24"],"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":[["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","GLIMEPIRIDE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","NOVOLIN R","","","Select","Select",""],["","","NOVOLIN N","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","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":""}]}]}