{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah M Godowsky","gend":1,"currentgend":"","add":"330 MAIN ST","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1951-07-13","age":"","mstatus":"","insh":"10000050715","cliId":"","pno":2078469443,"cno":"","email":"debbiegodowsky@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":"330 MAIN ST","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2078741483,"pcpnpi":1861451080,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2HT5D86AM82","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M542","M2560","M62838","M792","G5601","M1811","M5412","E559","E785","F1010","D2371","R6889","R110","R030","R239","R051","Z0001","L570","L821","L578","M5011","M4722","M4312","Z1231","M79671","Z978","L819","R21","Z0101","M722","M8588","J208","Z23","M79644","M65311","M19041","H11152","H18413","H2513","Z1211","K5190","K5730","B86","S81802A","W010XXA","M79673","D492","Z0000","R7309","M898X1","R1012","M85859","M7542","Z03818","M654","Z4889","M75112","M1812","M79645","M25512","M19012","S43422D","S43003A","X509XXD"],"date":["2023-02-21","2023-02-21","2023-02-21","2023-02-21","2023-06-01","2023-12-19","2022-12-30","2025-06-13","2025-06-13","2025-06-13","2024-07-23","2023-12-28","2023-01-16","2023-11-20","2023-11-20","2023-11-20","2025-06-30","2025-02-11","2024-10-03","2024-10-03","2022-12-30","2022-12-30","2022-12-30","2025-03-04","2025-07-10","2025-01-16","2024-07-23","2024-07-23","2024-11-04","2025-08-26","2025-03-25","2025-02-26","2023-05-11","2023-12-19","2023-12-19","2023-12-19","2024-02-16","2024-02-16","2024-02-16","2025-04-23","2025-04-23","2025-04-23","2023-07-05","2024-06-08","2024-06-08","2025-07-10","2025-02-11","2024-06-13","2023-05-04","2022-11-23","2022-09-14","2022-09-14","2022-05-17","2022-04-11","2022-04-05","2022-04-05","2022-03-22","2022-03-04","2021-11-15","2022-02-15","2022-01-07","2022-02-15","2022-01-17","2022-01-17"],"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":[["","","NALTREXONE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUZONE TRIVALENT 2024-2025","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PERMETHRIN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","OXYCODONE 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":""}]}]}