{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbara H Taylor","gend":1,"currentgend":"","add":"5 TOLMAN RD","city":"PEAKS ISLAND","state":"ME","zip":"04108","dob":"1947-12-24","age":"","mstatus":"","insh":"10000052581","cliId":"","pno":2077664486,"cno":"","email":"btaylormaine@gmail.com","ename":"","eno":"","pphy":"MURRAY PULSIFER, KRISTY A","ppno":2078741489,"pcpadd":"InterMed,100 Foden Rd Ste 203","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 TOLMAN RD","madd2":"","madd3":"","mcity":"PEAKS ISLAND","mstate":"ME","mzip":"04108","pcpfaxno":2078741483,"pcpnpi":1356310098,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7UY3D65DN78","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E039","H2511","N135","Q632","H2512","M1990","D122","D123","D125","K5730","R071","R0989","Z8041","N83201","M810","Z0000","Z1211","R195","R030","R002","R42","R000","E1136","H2513","I10","K219","N2889","R519","N83291","Z1231","R0609","S80862A","W57XXXA","N281","N1330","K5790","N3941","N130","M8588","H35372","Z20822","N390","Z0001","Z87448","N939","H5203","R102","Z1212","R059","S80861A","N393","R6889","N8189","R32","N8110"],"date":["2025-10-27","2023-02-23","2025-02-06","2025-02-06","2023-03-23","2023-03-23","2023-03-21","2023-03-21","2023-03-21","2023-03-21","2023-02-16","2023-02-16","2023-02-16","2024-01-30","2025-07-21","2024-01-15","2023-03-21","2023-03-21","2024-12-04","2024-12-04","2024-12-04","2024-12-13","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2025-01-20","2024-09-10","2024-01-30","2025-08-21","2023-05-04","2024-11-03","2024-11-03","2025-01-14","2025-01-14","2025-01-14","2025-01-16","2025-01-14","2025-05-14","2024-07-22","2024-04-11","2024-04-11","2023-01-05","2024-05-14","2024-05-03","2023-07-17","2023-02-02","2023-01-31","2023-01-10","2023-01-10","2023-01-10","2022-03-21","2022-06-01","2022-06-01","2022-06-01"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","ZOLEDRONIC ACID","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ACETAZOLAMIDE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MODERNA 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":[]}},{"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":""}]}]}