{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Belinda Veilleux","gend":1,"currentgend":"","add":"23 LAFAYETTE ST","city":"AUGUSTA","state":"ME","zip":"04330","dob":"1950-08-19","age":"","mstatus":"","insh":"10000048373","cliId":"","pno":2072156686,"cno":"","email":"lindavex@gmail.com","ename":"","eno":"","pphy":"BROWN, JASON","ppno":2076218800,"pcpadd":"Augusta Family Medicine,15 Enterprise Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"AUGUSTA FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"23 LAFAYETTE ST","madd2":"","madd3":"","mcity":"AUGUSTA","mstate":"ME","mzip":"04330","pcpfaxno":2076218801,"pcpnpi":1740592658,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9QY0V00CC30","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0001","Z0000","E119","R0989","E785","Z1231","S62512A","S6292XA","G4733","R739","E039","I10","I340","L218","L815","L813","L821","M180","M19041","L570","D225","L814","L718","R6889","S6992XA","M1812","Z23","Z0100","S62512D","X58XXXD","Z87891","Z8781","N390","D229","L820","L298","L538","M1831","I420","M810","S62619A","R399","W010XXA","Z122","H40013","Z780","S62502A","Y92481","Z13820","I429","I3489","R17","I422","I080","G4730","R109","R143","Z7189","I425","I2510","I5022","M19049","I7090","M5134","H5213","M8589"],"date":["2022-11-29","2025-01-23","2024-06-27","2023-12-05","2024-03-07","2025-03-10","2024-12-10","2024-11-27","2023-06-13","2023-10-20","2025-01-23","2024-03-07","2024-11-13","2025-06-18","2025-06-18","2025-06-18","2025-06-18","2025-05-27","2025-01-07","2024-06-18","2023-06-19","2024-06-18","2023-06-19","2023-02-06","2024-11-26","2024-11-26","2024-12-10","2024-12-20","2025-01-21","2025-01-21","2025-05-27","2025-05-27","2025-10-18","2024-06-18","2024-06-18","2024-06-18","2024-06-18","2025-01-07","2025-07-25","2025-01-23","2024-12-10","2024-02-16","2024-11-27","2025-03-15","2024-12-20","2024-01-31","2024-11-26","2024-11-26","2024-01-31","2024-11-13","2024-11-13","2022-08-10","2022-08-09","2022-08-09","2022-08-12","2022-08-12","2022-07-14","2022-06-20","2022-06-01","2022-06-01","2022-06-01","2022-03-16","2022-03-16","2021-11-23","2021-12-10","2022-01-21"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":""}]}]}