{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Laurel Mcdougall","gend":1,"currentgend":"","add":"38 PORTLAND AVE APT 205","city":"Old Orchard Beach","state":"ME","zip":"04064","dob":"1946-03-25","age":"","mstatus":"","insh":"10000051989","cliId":"","pno":2072326268,"cno":"","email":"","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":"38 PORTLAND AVE APT 205","madd2":"","madd3":"","mcity":"OLD ORCHARD BEACH","mstate":"ME","mzip":"04064","pcpfaxno":2075238597,"pcpnpi":1598054702,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6KK9RX4YK25","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R079","I4820","M25552","I2510","I480","M1612","Z23","M5442","Z471","E1165","E1169","E1122","I130","R5383","R42","S301XXS","N1831","R309","E032","F4322","I10","I110","I509","E119","M169","I25110","K219","E785","I5032","R300","I4891","S8991XA","Z7901","I499","R197","R399","R6884","R509","F418","E11649","Z96642","E8351","D649","I4510","R9439","J069","S301XXA","N179","I25119","I455","I4710","R21","L820","B029","L578","I454","Z87891","R053","U071","R0600","Z794","M1711","Z0000","Z5181","Z79899","S3662XA","S31603A","R059","I341","N189","R5382","R0683","R258","E11319","H25811","H35363","L304","L821","J029","R52","K5730","N3289","M25561","N1830","Z955","I517","I5189","I77810","I3139","E039","S7012XA","K589","H2511","L308","I083","R002","R1013","R918","Z03818","Z96659","I493","I459"],"date":["2024-03-27","2023-09-01","2024-10-10","2025-11-13","2025-11-13","2025-04-24","2025-10-20","2024-10-10","2025-05-25","2025-09-30","2025-06-30","2025-09-30","2025-06-30","2024-10-10","2024-10-10","2023-09-14","2025-04-03","2025-06-03","2025-04-03","2024-04-26","2025-11-13","2024-03-26","2024-03-26","2025-02-21","2025-04-11","2023-08-28","2024-03-04","2025-04-23","2023-09-25","2025-10-30","2024-05-21","2023-12-27","2024-12-18","2024-03-27","2025-11-03","2025-06-03","2025-11-03","2025-11-03","2025-11-03","2023-10-02","2025-06-06","2023-12-27","2023-12-27","2023-08-28","2023-08-30","2024-01-23","2024-03-09","2023-09-02","2023-08-30","2025-03-19","2025-03-19","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2023-10-12","2024-03-09","2024-01-23","2024-01-23","2024-01-23","2025-03-06","2023-12-10","2025-04-03","2024-01-16","2024-01-16","2023-09-01","2023-09-01","2024-01-23","2024-03-04","2023-09-21","2023-12-19","2023-12-31","2023-12-31","2023-10-18","2023-10-18","2023-10-18","2024-07-03","2024-07-03","2025-09-27","2025-09-27","2023-09-01","2023-09-01","2023-12-10","2023-09-06","2024-03-04","2024-03-04","2024-03-04","2024-03-04","2024-03-04","2025-04-23","2024-03-09","2023-08-23","2025-08-05","2025-02-25","2025-04-09","2023-10-01","2023-10-01","2023-10-16","2025-09-26","2023-08-23","2024-09-12","2024-09-12"],"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":[["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","TRIMETHOPRIM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","LANTUS","","","Select","Select",""],["","","SEMGLEE (YFGN) PEN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","INSULIN GLARGINE SOLOSTAR","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","GENTAMICIN SULFATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","DILT-XR","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","DILTIAZEM HCL","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}