{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lynn M Bak","gend":1,"currentgend":"","add":"20 CHANNEL POINT RD","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1951-08-14","age":"","mstatus":"","insh":"10000049181","cliId":"","pno":2072510030,"cno":2072510030,"email":"LYNNBAK@MSN.COM","ename":"","eno":"","pphy":"BUCHBERGER, GLENN K","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":"20 CHANNEL POINT RD","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2075238597,"pcpnpi":1598054702,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4CE9P34WA42","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M4312","G252","M5010","M50121","M50122","M50123","M4722","L821","D1801","M542","Z961","S61217A","W268XXA","T63464D","Z91038","T63454D","T63444D","Z471","Z96642","N1831","L820","M4807","G250","Z1231","M47812","M50222","Z7189","Z803","M25552","R6889","Z0000","H26492","H26491","M1612","L570","Z96641","L578","L814","Z85828","I129","I2510","R7303","D492","I10","N62","G890","C44729","L918","R208","N182","J069","H26493","R051","Z483","L905","Z4802","Z23","H2511","R202","M5412","M4802","Z4800","Z01818","H259","M25551","Z9882","R809","D225","E663","Z6827","S61217D","W268XXD","E7800","Z79899","R92323","Z91030","R0689","L509","M1611","M79659","H2512","M47816","M4316","E1122","N189","M79652","M79605","T782XXA","R079","T63441A","H2513","H04129","H43812","M8588","Z0100","M7701","Z0001","Z9189","M2011","M2041","M7741","M79671","M7910","M19071","R609"],"date":["2023-12-15","2023-08-30","2023-10-02","2023-06-29","2023-06-29","2023-06-29","2023-06-29","2025-11-11","2025-11-11","2023-06-29","2023-08-22","2024-06-10","2024-06-10","2025-09-22","2025-09-22","2025-09-22","2025-09-22","2024-03-01","2025-07-24","2025-09-08","2025-07-08","2023-12-15","2024-12-30","2025-02-05","2023-09-14","2023-09-14","2025-02-05","2025-02-05","2025-07-24","2023-07-13","2025-08-07","2024-10-10","2024-10-10","2023-03-13","2025-07-08","2024-03-01","2025-03-03","2025-03-03","2024-04-08","2025-09-08","2025-09-08","2025-09-08","2025-11-11","2025-04-14","2025-07-08","2025-01-30","2025-07-28","2025-11-11","2025-11-11","2023-03-13","2022-12-07","2024-01-19","2022-12-07","2025-08-11","2025-08-11","2025-08-11","2025-09-08","2023-07-19","2023-10-10","2023-10-10","2023-10-10","2023-03-21","2025-09-22","2023-07-19","2024-03-01","2025-06-18","2024-02-15","2025-03-03","2025-09-08","2025-09-08","2024-06-21","2024-06-21","2025-05-05","2023-03-13","2025-02-05","2023-05-03","2022-09-19","2022-09-19","2022-09-14","2022-08-01","2022-07-20","2022-08-01","2022-08-01","2022-07-20","2022-07-20","2022-08-01","2022-07-11","2022-07-12","2022-07-13","2022-07-12","2022-05-02","2022-05-02","2022-05-02","2022-04-18","2022-04-12","2022-03-14","2022-03-21","2022-03-23","2022-03-08","2022-03-08","2022-03-08","2022-01-21","2022-01-21","2022-01-21","2022-01-31"],"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":[["","","CAPVAXIVE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","NEFFY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","LOTEPREDNOL ETABONATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","LUMIGAN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","ADACEL TDAP","","","Select","Select",""],["","","PFIZER COVID-19 VACCINE (EUA)","","","Select","Select",""],["","","CYCLOBENZAPRINE 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":""}]}]}