{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Amber I Ruby","gend":1,"currentgend":"","add":"37 CROSS ROAD","city":"WINTHROP","state":"ME","zip":"04364","dob":"1951-06-20","age":"","mstatus":"","insh":"10000048648","cliId":"","pno":2073776046,"cno":2074466247,"email":"WINTHROPELECTRICCO@YAHOO.COM","ename":"","eno":"","pphy":"DECKER, CHRISTOPHER C","ppno":2077958475,"pcpadd":"272 CONGRESS ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41013637","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"37 CROSS ROAD","madd2":"","madd3":"","mcity":"WINTHROP","mstate":"ME","mzip":"04364","pcpfaxno":2077958490,"pcpnpi":1871023127,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8F13RM7EE92","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4700","Z0000","I2510","I10","E7800","I4710","R0683","R400","E669","R059","R0602","G4733","R0601","I318","R42","R600","Z20822","J0190","J209","G8929","M1712","M25562","M1711","M25561","B372","L03313","N3941","J069","H6693","R918","Z289","Z1231","R92323","Z23","N200","R911","Z0001","Z6841","E6601","J309","L304","H35013","K219","R21"],"date":["2025-07-16","2023-12-08","2025-06-21","2025-07-14","2023-12-08","2025-10-28","2025-07-16","2025-07-16","2025-07-16","2025-09-16","2025-06-21","2025-10-18","2025-01-07","2025-01-07","2025-10-28","2025-10-28","2023-01-10","2023-01-10","2023-01-10","2024-10-08","2024-10-08","2024-10-08","2024-10-08","2024-10-08","2023-06-19","2023-05-22","2025-05-20","2025-05-12","2023-01-24","2025-01-27","2022-11-30","2025-08-19","2025-08-19","2025-05-20","2025-06-21","2025-06-21","2025-10-27","2025-08-24","2025-08-24","2025-05-20","2024-05-13","2023-07-28","2025-01-10","2022-10-03"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","TOLTERODINE TARTRATE ER","","","Select","Select",""],["","","MIRABEGRON ER","","","Select","Select",""],["","","TROSPIUM CHLORIDE ER","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}