{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Connie I Shiebler","gend":1,"currentgend":"","add":"940 POPHAM RD","city":"PHIPPSBURG","state":"ME","zip":"04562","dob":"1947-06-19","age":"","mstatus":"","insh":"10000053627","cliId":"","pno":2073892416,"cno":"","email":"","ename":"","eno":"","pphy":"CARR, SUZANNE","ppno":2073734700,"pcpadd":"Parkview Family Health,329 Maine St","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"940 POPHAM RD","madd2":"","madd3":"","mcity":"PHIPPSBURG","mstate":"ME","mzip":"04562","pcpfaxno":2078287850,"pcpnpi":1679513402,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4N54DP7VA64","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","R7401","I4710","R002","M4726","M5432","S82024A","D485","M25562","M25462","Z1231","R42","J189","Z20822","H53032","H47033","H02055","R600","R413","G8929","Z0000","E782","M810","J188","J029","M25561","M79604","H8113","I479","R053","I4720","S82001A","M25461","I080","R1011","D72829","R2241","E785","M5116","M5450","R262","R051","R6889","R918","R059","R509","I517","K5900","K449","I700","Z131","Z6379","R9089","R4182","G319","J320","R0781","Z9849","H04129","R7309"],"date":["2025-07-03","2024-03-18","2025-05-14","2024-04-24","2023-12-29","2023-12-29","2024-11-14","2023-06-08","2024-02-07","2023-11-24","2025-07-29","2024-02-12","2023-08-11","2024-02-12","2025-05-23","2025-05-23","2025-05-23","2024-11-23","2023-10-09","2024-02-07","2025-07-03","2025-07-03","2025-07-03","2024-11-12","2024-11-12","2024-12-09","2024-11-23","2024-03-18","2025-05-14","2024-04-17","2025-05-14","2024-11-12","2024-11-12","2024-03-21","2024-02-12","2024-03-18","2024-11-23","2024-04-24","2023-06-02","2023-06-02","2023-06-02","2023-12-18","2023-01-11","2023-08-11","2023-06-02","2024-11-12","2023-06-02","2023-08-11","2023-08-11","2024-11-12","2024-06-07","2024-12-09","2022-11-01","2022-10-27","2022-10-27","2022-10-27","2022-10-04","2022-04-13","2022-04-13","2022-04-05"],"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",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","PREVNAR 20","","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}