{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ruth Sholl","gend":1,"currentgend":"","add":"90 MCGRATH POND RD","city":"OAKLAND","state":"ME","zip":"04963","dob":"1951-04-14","age":"","mstatus":"","insh":"10000048237","cliId":"","pno":2074657523,"cno":"","email":"tomsholl7@gmail.com","ename":"","eno":"","pphy":"LEBLANC, CHRISTINA","ppno":2078731098,"pcpadd":"MaineGeneral Medical Center,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"THAYER INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"90 MCGRATH POND RD","madd2":"","madd3":"","mcity":"OAKLAND","mstate":"ME","mzip":"04963","pcpfaxno":2078615461,"pcpnpi":1154773935,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6UP8YQ2WD62","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E042","I129","M67912","M25512","M62838","R278","F4322","R200","R197","R5383","I10","Z1283","Z1231","E213","E210","E892","E8352","L649","Z0001","E871","E7800","Z87891","N62","N6311","K219","K52839","C50911","M2061","M8580","Z510","J029","Z170","Z79811","N6489","Z853","Z923","R921","N189","L918","M810","N6082","I878","K580","Z1211","Z801","L821","K529","D125","K5730","K621","K641","K222","Z09","K2950","K5010","R195","D128","K6389","R92333","M85812","M19012","M8589","Z780","Z0100","M19011","M25511","J3489","Z833","Z01810","I447","L720","L820","R739","Z13820","I999","R944","N6310","C50411","Z90710","M7732","D649","R252","C50811","Z79899","M2041","M2042","M2011","Z171","Z0101","Z9089","I739","K921","I080","I318","C50919","E7849","R6889","G43909","M19042","M19041","L02416","L03116","G4762","L03119"],"date":["2024-11-14","2025-09-10","2024-08-26","2024-08-26","2024-08-26","2024-08-26","2025-11-06","2024-11-05","2023-04-10","2025-10-17","2025-10-10","2024-03-12","2025-10-30","2024-08-30","2023-09-21","2023-11-13","2023-09-21","2024-09-19","2023-08-18","2025-10-22","2025-03-15","2025-09-05","2025-01-03","2023-10-11","2023-10-03","2023-10-03","2025-02-28","2023-12-13","2023-08-18","2024-02-19","2023-03-27","2024-05-23","2024-05-23","2025-03-04","2025-09-05","2025-03-04","2024-10-28","2024-10-17","2024-09-19","2024-11-15","2025-03-04","2022-12-14","2022-12-12","2022-12-12","2022-12-12","2025-03-26","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2025-09-05","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2025-10-30","2024-04-22","2024-04-22","2024-10-30","2024-10-30","2024-10-18","2024-06-19","2024-06-19","2023-04-10","2023-04-10","2025-02-11","2025-08-20","2024-06-19","2024-06-19","2023-08-21","2024-10-30","2025-06-26","2023-11-15","2023-12-04","2024-02-05","2023-11-07","2023-12-13","2025-04-29","2023-06-01","2023-10-11","2024-01-18","2023-12-13","2023-12-13","2023-12-13","2023-12-20","2023-06-20","2023-10-23","2025-06-25","2025-06-27","2025-06-05","2025-06-05","2025-04-30","2025-08-20","2023-06-26","2022-09-26","2022-09-26","2022-09-26","2022-08-25","2022-08-25","2022-08-16","2022-08-18"],"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":[["","","TRAMADOL HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","BUDESONIDE EC","","","Select","Select",""],["","","MINOXIDIL","","","Select","Select",""],["","","BUDESONIDE DR","","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SUMATRIPTAN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":[]}},{"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":""}]}]}