{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathleen A Reilly","gend":1,"currentgend":"","add":"12 PATRICIA AVE","city":"RAYMOND","state":"ME","zip":"04071","dob":"1948-08-21","age":"","mstatus":"","insh":"10000047488","cliId":"","pno":2077125191,"cno":"","email":"kthreilly@gmail.com","ename":"","eno":"","pphy":"LAVALLEE, HEATHER A","ppno":2078930290,"pcpadd":"100 FODEN ROAD,WEST BUILDING SUITE 103","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062351","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 PATRICIA AVE","madd2":"","madd3":"","mcity":"RAYMOND","mstate":"ME","mzip":"04071","pcpfaxno":2078280188,"pcpnpi":1841569720,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5HM7D82CU73","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S42201A","Z853","Z471","Z96611","M25561","M25562","I4819","M8588","S42412A","Z96612","Z7901","I509","M170","M1711","L570","L821","Z85828","I10","G4733","G8918","M1712","W19XXXA","S42231A","S0083XA","S42402A","I454","D0462","D492","L853","S60944A","M25511","M79641","M7989","M19041","Z79899","S42412D","Z13820","M9742XA","Z0101","Z0000","S42302A","Z4789","I429","I480","I447","Z1231","D0439","M19011","M79645","W19XXXD","S42201D","S6992XA","S63602A","S0990XA","W1849XA","M79642","M19042","E785","F419","E669","Z043","G319","R9089","I4891","I5022","I484","I4729","M7541","S43401D","M25522","M79632","M79602","M25512","F330","Z0001","S42251A","S42261A","S42422A","M25422","S0101XA","W010XXA","Y92002","R220","S0081XA","M47812","I6523","R519","F5104","S43401A","I4892","I2510","I110","Z01812","M85851","M85852","Z20822","R921","Z0100","L578","Z08","Z98890","H04129","R0781","Z87891","S2231XA","M5030","G9389","I517","I080","I5030","I2720","I871","M8580"],"date":["2025-03-25","2025-09-25","2024-11-26","2025-11-11","2025-06-30","2025-06-30","2023-10-03","2025-05-22","2023-11-21","2025-03-31","2024-09-23","2023-11-16","2025-11-14","2025-10-09","2025-09-09","2025-09-09","2025-09-09","2023-11-21","2023-11-21","2023-11-21","2025-10-02","2024-11-12","2024-10-07","2024-10-07","2023-11-05","2023-09-20","2023-04-19","2025-09-09","2023-04-19","2025-05-22","2024-10-30","2025-05-22","2025-05-22","2025-05-22","2025-08-01","2024-04-09","2025-05-22","2023-11-21","2024-12-18","2023-06-28","2023-11-05","2024-02-13","2025-04-22","2025-04-21","2024-09-23","2025-09-11","2025-09-09","2024-11-12","2023-08-30","2023-08-30","2025-03-27","2023-08-30","2023-08-30","2023-11-05","2023-08-12","2023-08-30","2023-08-30","2024-11-12","2024-11-12","2024-11-12","2024-09-30","2023-08-12","2023-08-12","2023-09-19","2022-12-02","2022-12-02","2023-09-20","2022-12-12","2022-12-12","2024-04-08","2024-04-08","2024-04-08","2025-02-04","2023-12-13","2024-11-04","2024-11-12","2024-11-12","2023-11-05","2023-11-05","2023-08-12","2023-08-12","2023-08-12","2023-11-05","2023-11-05","2024-09-30","2024-09-30","2024-09-30","2022-11-11","2022-11-17","2022-10-03","2022-10-03","2022-10-03","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-08-12","2022-08-15","2022-08-25","2022-08-12","2022-08-12","2022-08-29","2022-07-27","2022-07-27","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-06-20","2022-06-20","2022-06-20","2022-06-20","2022-06-17"],"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":[["","","XARELTO","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","COLCHICINE","","","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":""}]}]}