{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathleen Leavis","gend":1,"currentgend":"","add":"81 DOUGLASS ST","city":"PORTLAND","state":"ME","zip":"04102","dob":"1950-06-13","age":"","mstatus":"","insh":"10000049826","cliId":"","pno":2073296625,"cno":2077742016,"email":"kleavis754@aol.com","ename":"","eno":"","pphy":"MARTIN, STEPHEN","ppno":2078469013,"pcpadd":"Intermed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"81 DOUGLASS ST","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04102","pcpfaxno":2078741483,"pcpnpi":1740249861,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3V06MW1MJ46","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S52531A","M25531","H2512","M549","F411","F331","H2511","J45909","E785","F418","M25631","R601","M6281","J020","R0982","R590","M810","M7522","C5700","E66811","E6609","Z6833","M533","S39012A","M25512","M5450","M9903","M9902","M9901","Z1501","Z7189","Z8540","M65341","E1165","M778","S3992XA","Z1211","K5730","N3090","Z1231","R053","J40","Z87440","M75112","M19012","M25561","M1711","R09A2","M5136","M4316","M8588","K869","R109","Z23","Z86010","E039","Z0001","R1030","E669","L570","D2271","H40003","R300","M7542","G8929","K8689","K760","Z90710","M65342","D492","Z85828","D225","L814","S52531D","H2513","H04123","Z8543","M19071","S52301A","M19072","S52501A","S60511A","W1789XA","Y93K1","R1084","M25569","R7309","L578","L853","L820","R208","S52531P","R194","R152","Z0000","E119","H40013","H16223","R202","F32A","G620","R6889","D701","L299","R7303","C44321","R945","U071","L821"],"date":["2024-10-25","2024-10-25","2024-04-18","2023-01-24","2025-11-03","2025-11-03","2024-04-04","2024-04-18","2025-09-09","2024-04-04","2024-05-30","2024-05-30","2024-05-30","2023-11-29","2023-11-29","2023-11-29","2024-08-30","2023-04-06","2025-03-26","2025-03-18","2025-02-13","2025-02-13","2025-10-03","2025-10-03","2023-04-26","2023-03-08","2023-03-08","2023-03-08","2023-03-08","2023-11-20","2023-11-24","2025-01-16","2024-12-12","2025-09-09","2023-07-27","2025-09-18","2024-06-06","2024-06-06","2025-01-18","2024-02-20","2024-02-06","2024-02-06","2025-01-18","2023-06-29","2023-06-29","2023-08-30","2025-03-06","2024-04-03","2023-01-24","2023-01-24","2024-02-20","2023-09-20","2023-09-20","2025-10-15","2024-06-06","2025-09-09","2025-09-09","2023-09-08","2024-04-11","2023-12-08","2023-07-28","2023-12-14","2024-07-26","2023-03-24","2025-10-10","2023-09-20","2023-09-20","2023-11-20","2024-12-12","2023-07-28","2023-07-28","2023-12-08","2023-12-08","2024-05-15","2024-03-25","2024-03-25","2025-06-04","2025-05-14","2024-04-05","2025-05-14","2024-04-05","2024-04-05","2024-04-05","2024-04-05","2023-11-24","2023-08-17","2023-08-17","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2024-06-05","2023-11-09","2023-11-09","2024-08-22","2025-01-09","2025-01-09","2025-01-09","2023-02-16","2024-11-12","2023-01-04","2023-01-31","2022-10-05","2022-10-20","2022-07-18","2022-07-20","2022-07-06","2022-06-14","2022-05-27"],"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":[["","","CLONAZEPAM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}