{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tammy L Ruel","gend":1,"currentgend":"","add":"80 WASHINGTON STREET APT A25","city":"BIDDEFORD","state":"ME","zip":"04005","dob":"1963-04-21","age":"","mstatus":"","insh":"10000046762","cliId":"","pno":2073434179,"cno":"","email":"DECLINED@10302025.com","ename":"","eno":"","pphy":"TRAVIS, PAMELA W","ppno":2072838800,"pcpadd":"SMCH Family Medicine,13 Industrial Park Rd","pcpcity":"Saco","pcpstate":"ME","pcpzip":"04072","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"80 WASHINGTON STREET APT A25","madd2":"","madd3":"","mcity":"BIDDEFORD","mstate":"ME","mzip":"04005","pcpfaxno":2072943561,"pcpnpi":1376659102,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8M36DP1AU56","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T82858A","N186","M869","Z0000","L0390","E1122","Z992","I70203","L03115","Y832","I499","S92421A","M79662","R2242","I10","R7982","E11628","L089","L03116","I5042","E782","S90421A","R52","Z760","E11621","T8189XD","I739","L97522","I120","T8189XA","R0902","S81809A","I872","G20","M79605","S91102A","M19072","R9431","I509","T8743","R059","R509","K219","R4182","I517","S92421D","R0602","R600","R519","E1169","Z23","Z4801","I70222","Z136","I70221","E785","I70291","T8789","Y835","S98112A","Z89412","Z89411","B349","G6289","E875","C4921","I70235","D631","I080","I5030","S0003XA","S1093XA","J811","M86172","S0001XA","R011","S91302D","R918","R2241","R079","E1140","Z114","S0990XA","E878","J45909","R069","R0600","L97529","I878","Z712","E8770","M79671","T82590A","Z1152","T82510A","E113593","E1142","E6601"],"date":["2025-04-22","2025-08-04","2025-07-08","2024-08-06","2025-08-16","2025-07-01","2025-07-07","2025-07-18","2025-06-23","2025-04-22","2025-07-18","2025-06-13","2023-11-13","2023-11-13","2025-07-22","2025-06-28","2025-07-23","2025-07-23","2023-11-20","2023-11-20","2023-11-13","2025-04-17","2025-07-24","2025-07-24","2025-07-30","2024-07-25","2025-07-31","2024-07-25","2025-07-07","2024-04-25","2025-07-25","2023-05-31","2023-05-31","2023-05-31","2023-11-13","2024-02-16","2024-02-10","2025-04-30","2025-07-12","2025-07-02","2025-07-07","2025-07-07","2025-07-22","2025-07-08","2023-04-11","2025-05-29","2025-04-30","2025-07-05","2023-11-14","2025-06-11","2025-07-27","2023-12-05","2024-04-03","2025-05-01","2025-07-22","2025-07-22","2025-07-22","2025-07-22","2025-07-22","2024-07-25","2024-05-30","2025-07-21","2024-11-06","2025-05-20","2025-07-01","2025-06-17","2025-07-30","2025-07-30","2025-06-13","2025-06-13","2024-06-27","2024-06-27","2025-06-11","2023-11-20","2024-06-27","2023-04-11","2024-06-15","2025-06-15","2025-06-17","2024-11-08","2022-12-20","2023-06-20","2024-06-27","2025-06-12","2023-11-17","2025-04-30","2025-06-16","2024-05-30","2025-08-16","2025-08-16","2024-12-01","2025-06-11","2022-09-13","2022-06-08","2022-04-26","2021-12-23","2021-12-23","2021-12-23"],"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":[["","","HYDRALAZINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AURYXIA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CINACALCET HCL","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","GLIMEPIRIDE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","MINOXIDIL","","","Select","Select",""],["","","CALCITRIOL","","","Select","Select",""],["","","SEVELAMER CARBONATE","","","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":""}]}]}