{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diana D Dunn","gend":1,"currentgend":"","add":"101 EAST BUCKFIELD RD","city":"BUCKFIELD","state":"ME","zip":"04220","dob":"1942-08-17","age":"","mstatus":"","insh":"10000045563","cliId":"","pno":2073363310,"cno":2075001344,"email":"declined@03112025.com","ename":"","eno":"","pphy":"BUSTAMANTE, ANTHONY","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":2073305564,"add2":"","add3":"","madd1":"101 EAST BUCKFIELD RD","madd2":"","madd3":"","mcity":"BUCKFIELD","mstate":"ME","mzip":"04220","pcpfaxno":2075238586,"pcpnpi":1306229521,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9NG0J76EW01","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1711","N3941","R3581","N3281","N952","Z01818","Z471","Z01810","L649","R079","D171","Z0000","M8580","E7800","R7303","I10","B079","L820","D225","L821","L7634","M180","R002","S21202A","K7689","N281","J209","R222","Z1231","M62838","M2012","M19072","Z1211","R921","G8918","E785","M25561","M7591","M170","H353132","Z0101","M25461","Z96651","Z4789","M1811","M1812","M5430","M179","M79672","M25562","H903","I422","R011","L570","M79643","B029","T148XXA","W19XXXA","R52","Z23","M25569","M25862","M8588","M25511","G4700","M19011","M19012","S6991XA","M7541","M7542","M542","R39198","Z03818"],"date":["2025-07-09","2024-03-15","2024-03-15","2024-03-15","2024-03-15","2025-06-30","2025-09-02","2025-06-30","2025-11-04","2023-06-26","2024-03-13","2024-11-07","2024-07-25","2025-11-07","2024-07-25","2025-07-09","2023-04-04","2025-11-04","2025-11-04","2025-11-04","2024-04-26","2024-08-22","2024-08-27","2024-03-16","2023-07-25","2023-07-18","2024-01-12","2024-01-12","2024-12-09","2025-06-05","2024-10-28","2024-10-28","2024-06-26","2024-12-31","2025-07-09","2025-07-09","2025-04-23","2023-04-04","2023-12-29","2024-07-23","2024-07-23","2025-07-24","2025-07-24","2025-09-02","2023-06-01","2023-06-01","2025-02-10","2025-02-10","2024-09-03","2025-04-23","2025-08-18","2023-06-26","2023-06-26","2023-05-02","2023-05-02","2025-06-06","2023-10-09","2025-04-23","2022-08-23","2022-04-19","2022-03-29","2022-03-29","2021-11-29","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-02-24","2022-02-03"],"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":[["","","BOOSTRIX TDAP","","","Select","Select",""],["","","MINOXIDIL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FLUZONE 2025-2026","","","Select","Select",""],["","","CAPVAXIVE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PREMARIN","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUBLOK QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUBLOK TRIVALENT 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE QUAD 2022-2023","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}