{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda M Hartford","gend":1,"currentgend":"","add":"90 GOOSE FLAT RD","city":"CAMBRIDGE","state":"ME","zip":"04923","dob":"1952-02-22","age":"","mstatus":"","insh":"10000053797","cliId":"","pno":2072775581,"cno":2072701444,"email":"lkensell@tdstelme.net","ename":"","eno":"","pphy":"PISCULLI, JENNY T","ppno":2078615000,"pcpadd":"Maine Dartmouth Family Medicine,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"90 GOOSE FLAT RD","madd2":"","madd3":"","mcity":"CAMBRIDGE","mstate":"ME","mzip":"04923","pcpfaxno":2078615101,"pcpnpi":1538190384,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1NY0RH7XK06","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N9089","R0609","Z08","C50911","I10","M5450","L900","Z8544","D0512","I4891","E039","C519","N993","I480","R079","R0602","N904","J069","Z13820","R059","S93401A","R0600","Z1231","M8580","Z79811","Z853","N3281","Z1589","R921","N905","H903","R300","Z510","R5383","Z1239","R9230","R92333","Z86000","Z9221","I515","R9431","N819","N393","N390","R351","Z0000","I890","Z1211","D124","Z23","R9439","Z7901","Z20822","C50212","J351","H73893","R92332","K219","F32A","C50511","Z170","N8110","F418","R112","H6122","N6320","H8190","Z1152","R928","L280","Z98890","Z780","H9319","Z86010","Z148","Z800","H26493","Z961","J101","Z0100","R32","N907","N816","K469","W0110XA","Z01810","H26491","Z79890","N952","N766","M8589","D500","K922","C50312","R922","Z0001","J40","Z8540","M109","M19072"],"date":["2025-06-24","2025-09-22","2025-10-20","2023-12-27","2025-07-10","2023-12-27","2025-05-09","2023-08-11","2024-10-07","2025-09-22","2025-10-24","2023-01-30","2025-10-24","2025-07-10","2023-03-30","2025-08-05","2023-06-01","2024-02-22","2025-04-07","2025-01-30","2024-07-19","2025-06-02","2025-05-22","2025-04-07","2024-10-07","2025-10-16","2025-02-18","2024-01-23","2023-10-25","2025-05-09","2023-10-12","2025-11-06","2024-07-01","2025-01-30","2024-11-07","2024-11-07","2025-10-16","2025-05-27","2025-05-27","2023-03-29","2023-03-29","2025-10-14","2023-12-06","2023-09-08","2023-09-08","2025-11-06","2024-11-20","2024-08-29","2024-08-29","2023-04-25","2023-03-30","2024-04-02","2024-02-27","2023-04-12","2023-05-18","2023-05-18","2023-12-13","2025-10-24","2024-04-05","2023-04-12","2024-10-07","2025-10-24","2025-10-24","2025-02-21","2023-11-03","2024-04-24","2025-02-21","2025-02-21","2023-10-12","2023-06-01","2024-01-17","2025-04-07","2023-10-12","2023-10-31","2023-10-31","2023-10-31","2025-01-08","2025-01-08","2024-02-27","2023-07-10","2023-07-03","2025-10-24","2025-10-24","2025-10-24","2024-07-19","2024-04-02","2025-02-04","2023-01-18","2024-11-21","2022-11-17","2022-10-04","2022-10-21","2022-10-12","2022-10-06","2022-10-06","2022-09-20","2022-08-31","2022-08-24","2022-09-03","2022-09-03"],"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":[["","","XARELTO","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","DILT-XR","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","LETROZOLE","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","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":""}]}]}