{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brenda P Fox","gend":1,"currentgend":"","add":"46 REGAN LN","city":"PORTLAND","state":"ME","zip":"04103","dob":"1949-12-05","age":"","mstatus":"","insh":"10000048946","cliId":"","pno":2076713150,"cno":"","email":"foxiladee@ymail.com","ename":"","eno":"","pphy":"CATHCART, SCOTT","ppno":2077745816,"pcpadd":"Intermed,84 Marginal Way Ste 700","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"46 REGAN LN","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2078741483,"pcpnpi":1659876571,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4WC5Y04HH95","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1159","I10","M810","Z833","E039","E7800","B078","R238","B001","L578","M1811","R911","Z23","Z0001","F17200","F331","Z131","R071","M549","M79644","R079","Z0101","H02839","M1990","C44519","R1319","Z139","M25561","L819","U071","R21","H1013","D225","R208","L298","L820","R58","Z0000","S42255A","M25512","L538","J069","R059","R062","K219","K222","K449","R1310","R091","S4992XA","R6889","R7301","J9811","M1711","H02831","H02834","H02102","H02105","K2100","F418","L821","Z08","Z85828","C44722","L814","D2261","B351","D485"],"date":["2025-09-10","2025-09-10","2025-09-10","2025-09-10","2025-09-10","2025-09-10","2023-07-13","2023-07-13","2023-07-13","2023-07-13","2025-07-11","2025-05-02","2023-01-24","2025-08-29","2023-01-24","2023-01-24","2024-08-08","2023-01-17","2023-01-17","2025-07-11","2024-11-06","2024-11-18","2024-01-22","2025-07-11","2023-09-18","2023-06-05","2024-05-09","2025-04-16","2025-08-29","2025-08-29","2023-09-15","2025-08-28","2023-09-18","2023-09-18","2023-09-18","2023-09-18","2023-09-18","2024-08-19","2024-02-23","2024-02-19","2023-09-11","2023-07-20","2023-07-20","2023-07-20","2023-11-02","2023-11-02","2023-11-02","2023-11-02","2024-11-04","2024-02-23","2022-12-29","2024-05-09","2025-05-02","2025-04-29","2024-01-22","2024-01-22","2023-01-12","2023-01-12","2023-11-02","2023-11-02","2022-06-23","2022-06-23","2022-06-23","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2022-05-09"],"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":[["","","IBU","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","PENCICLOVIR","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DENAVIR","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}