{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary E Pickens","gend":1,"currentgend":"","add":"8 BEECH DRIVE","city":"SABATTUS","state":"ME","zip":"04280","dob":"1949-01-08","age":"","mstatus":"","insh":"10000049594","cliId":"","pno":2073758876,"cno":"","email":"opt-out@optout.com","ename":"","eno":"","pphy":"LONGFELLOW, KAREN A","ppno":2075826608,"pcpadd":"44 MATHEWS AVE,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49015233","pcpcounty":"","pcpid":"","pcpname":"GARDINER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 BEECH DRIVE","madd2":"","madd3":"","mcity":"SABATTUS","mstate":"ME","mzip":"04280","pcpfaxno":"","pcpnpi":1295049187,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5RP9D86VA39","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F329","J45909","M75102","G40909","J984","N200","N3941","Z87891","M9902","M1711","E6601","Z6842","G4733","G4734","Z96651","M25561","N1831","Z1231","D126","F419","Z01818","N390","F32A","M19012","M898X2","N3281","E113213","Z471","E118","Z7951","Z9981","M542","G8929","M9901","Z0000","M5450","M1612","M25562","F4321","S52502A","E1122","M25532","R102","E119","Z7984","Z7985","H35371","H43821","Z01811","D508","E538","Z87442","S060X0A","R42","K449","K5730","K429","R918","R0602","R5381","I10","G4730","M654","S52512A","W19XXXA","X58XXXA","M25461","S52512G","R296","M79651","T84032D","X58XXXD","W19XXXD","G8918","M25512","N281","R109","E1159","H8110","F4381","Z1211","E113211","E113212","Z98890","D124","M79652","Z780","W010XXA","Z95810","G4736","Z9989","H3562","R809","N182","Z79899","B370","M25531","E669","R92323","T8484XD","N1832","R519","G319","M47812","N2889","K5790","M948X6","Z733","M79602"],"date":["2025-09-30","2025-10-31","2024-01-31","2025-07-17","2025-10-31","2024-03-05","2024-07-09","2025-04-22","2024-05-22","2025-08-28","2024-08-05","2024-08-05","2025-03-14","2024-04-14","2025-08-28","2025-10-21","2024-07-08","2025-09-16","2023-01-03","2025-09-30","2025-11-11","2024-04-01","2025-10-28","2025-08-08","2025-01-15","2025-05-30","2025-09-04","2025-04-22","2025-03-24","2024-10-03","2024-10-03","2025-07-24","2024-11-11","2024-05-22","2025-08-26","2024-02-02","2025-10-28","2024-05-02","2025-03-18","2025-07-24","2024-10-24","2025-10-14","2024-02-03","2025-10-30","2025-04-24","2025-04-24","2025-05-01","2024-10-03","2025-11-11","2022-12-07","2022-12-19","2025-02-07","2025-07-24","2024-07-17","2024-06-06","2024-06-06","2024-06-06","2025-11-11","2023-01-26","2024-08-20","2024-08-20","2024-08-20","2025-10-28","2025-10-28","2025-10-28","2025-10-28","2025-01-16","2025-10-14","2025-08-26","2025-08-26","2025-10-21","2025-10-21","2025-10-21","2024-08-05","2025-07-24","2024-06-06","2024-04-17","2023-11-16","2023-12-26","2024-12-12","2023-07-24","2025-05-01","2025-05-01","2023-11-06","2023-07-24","2023-08-30","2024-04-10","2025-07-24","2025-07-24","2024-10-23","2024-10-23","2023-06-26","2023-11-15","2024-07-22","2023-11-02","2023-06-29","2025-07-17","2023-01-26","2025-09-16","2025-01-14","2023-06-19","2025-07-24","2025-07-24","2025-07-24","2022-11-02","2022-11-02","2022-10-13","2022-10-04","2022-08-23"],"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":[["","","PREGABALIN","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","POTASSIUM CITRATE ER","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","PRAZOSIN HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","CARBAMAZEPINE","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","EPITOL","","","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":{"indx":[],"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":""}]}]}