{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Andrea C Gabel Richards","gend":1,"currentgend":"","add":"424 LAMOINE BEACH RD","city":"ELLSWORTH","state":"ME","zip":"04605","dob":"1951-03-27","age":"","mstatus":"","insh":"10000048215","cliId":"","pno":2076673132,"cno":2072661637,"email":"Andreagr32751@gmail.com","ename":"","eno":"","pphy":"HANSON, CASEY S","ppno":2076675899,"pcpadd":"PO BOX 8,","pcpcity":"BAR HARBOR","pcpstate":"ME","pcpzip":"46090008","pcpcounty":"","pcpid":"","pcpname":"TRENTON HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"424 LAMOINE BEACH RD","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2078015123,"pcpnpi":1164536397,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8QQ4G72CQ02","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R87618","M9901","M9902","M4802","Z5189","R413","H47321","D3131","H35363","H43393","H8110","R42","L814","D225","L821","L720","Z0000","R87810","B977","M5412","M4124","J069","Z1151","Z01419","R0789","L910","H8190","H04129","L858","Z01812","M50123","N888","R29898","R202","G5600","I10","D485","R208","G5762","M2021","M2012","H903","M5413","I6523","H2511","H04123","H43813","K219","E785","R059","L905","L578","N83202","R9389","S80861A","Z87891","Z1231","R6889","S70361A","K589","R490","J310","M810","H2513","H00022","N858","Z6379","M549","R002","M9904","M79601","M542","M9903","M47817","M546","Z780","M9908"],"date":["2022-11-03","2025-08-28","2025-08-28","2024-04-05","2025-07-11","2025-06-20","2024-04-26","2025-01-13","2025-01-13","2025-01-13","2022-12-06","2025-08-12","2024-01-04","2024-01-04","2025-07-07","2024-01-04","2024-08-29","2023-08-23","2023-08-23","2023-12-12","2023-06-12","2025-06-12","2023-08-23","2023-08-23","2023-05-01","2025-07-07","2023-02-01","2023-02-10","2022-12-19","2022-10-10","2023-07-20","2022-11-11","2023-05-25","2023-05-25","2023-05-25","2025-03-21","2025-03-17","2025-03-17","2024-11-04","2024-11-04","2024-11-04","2025-05-21","2023-11-13","2022-12-12","2023-04-10","2023-04-10","2023-04-10","2023-11-13","2023-11-13","2025-06-12","2025-07-07","2025-07-07","2022-11-03","2023-05-15","2025-07-17","2023-11-13","2024-08-22","2023-09-11","2025-08-07","2024-06-10","2025-06-12","2025-06-12","2024-02-16","2024-06-28","2023-02-24","2022-10-12","2023-12-21","2022-11-22","2024-09-28","2024-06-10","2023-05-01","2023-09-07","2022-12-05","2022-12-05","2022-12-05","2023-09-07","2023-07-20"],"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":[["","","FLUOROURACIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PROMETHAZINE HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MECLIZINE HCL","","","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":""}]}]}