{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rachael A Wallace","gend":1,"currentgend":"","add":"34 AUTUMN CROSSING","city":"GRAY","state":"ME","zip":"04039","dob":"1974-07-05","age":"","mstatus":"","insh":"10000050287","cliId":"","pno":2073293149,"cno":"","email":"RACHWALLA74@gmail.com","ename":"","eno":"","pphy":"PIERCE, DANIEL C","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":"34 AUTUMN CROSSING","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":2078741483,"pcpnpi":1861451080,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5AJ8D41XU21","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F331","F4310","G40109","M62830","M549","M6281","M940","N029","F4312","F411","R319","M2550","R768","R700","G40909","M50322","M47812","F3162","D235","R4182","M7918","R509","J069","E785","Z13228","M5432","R0789","R3129","Z79899","D485","Z1159","Z130","R519","R109","M19012","D225","L821","L578","S29012A","R42","Z713","M329","M25569","H31092","M797","R8290","B349","J0190","Z20822","Z720","L989","G40309","D229","Z124","Z0000","G40209","F603","F17210","Z23","Z0389","R300","L918","Z0001","R921","R059","K429","Z0101","M25512","Y999","F439","Z1231","N951","L03039","R0781","R911","R6889","Z30011","N912","E669","F330","R21","E559","F3340","L309","S83411A","M7050","S8990XA","Z6839","E282","N83201","S83411D","Z6838","M25551","M160","W108XXA","M542","W109XXA","Y92009","M25561","R918","Z975","N870","S8991XA","M7989"],"date":["2025-11-11","2025-06-27","2025-09-15","2024-02-21","2024-02-21","2024-02-21","2023-11-10","2023-11-10","2025-10-28","2025-10-23","2023-12-08","2024-10-03","2024-10-03","2024-10-03","2025-04-13","2024-03-08","2024-03-08","2023-07-19","2024-04-09","2024-03-15","2024-08-28","2025-02-03","2025-02-03","2025-03-24","2025-03-24","2023-12-05","2023-12-05","2024-08-23","2025-08-26","2024-03-12","2025-03-24","2025-03-24","2024-07-20","2025-08-18","2024-01-30","2024-03-12","2024-03-12","2024-03-12","2024-02-13","2024-07-20","2024-12-23","2025-08-26","2025-08-26","2025-07-02","2024-07-20","2024-07-20","2023-02-21","2023-02-21","2023-02-21","2023-05-30","2024-04-09","2025-10-01","2024-03-12","2025-06-04","2024-03-26","2024-03-16","2025-01-27","2024-03-16","2024-09-11","2025-04-13","2023-11-02","2023-03-20","2025-03-31","2025-05-19","2023-02-21","2025-08-18","2024-07-01","2024-01-30","2024-01-30","2024-08-13","2024-11-07","2024-09-11","2024-10-21","2023-11-08","2023-11-08","2023-06-27","2023-05-25","2023-05-25","2023-05-25","2024-11-22","2022-10-26","2022-09-08","2022-07-14","2022-07-15","2022-04-25","2022-04-25","2022-04-12","2022-04-12","2022-04-08","2022-04-08","2022-03-01","2022-03-01","2021-12-11","2021-12-11","2021-12-11","2021-12-11","2021-12-11","2021-12-11","2022-02-20","2022-01-28","2022-02-03","2022-02-03","2022-02-02","2022-02-20"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","Select","Select",""],["","","LYLLANA","","","Select","Select",""],["","","ESTRADIOL (TWICE WEEKLY)","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","ZONISAMIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","NORETHINDRONE","","","Select","Select",""],["","","ERRIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","NYSTATIN","","","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":""}]}]}