{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brenda O Kern","gend":1,"currentgend":"","add":"38 COVESIDE LANE","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1952-04-09","age":"","mstatus":"","insh":"10000054257","cliId":"","pno":2078463054,"cno":"","email":"","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":"38 COVESIDE LANE","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2078741483,"pcpnpi":1861451080,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2PJ7KN4GA75","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z471","Z0000","M1711","Z23","H401231","Z1231","Z96651","I671","Z720","Z716","G5602","R000","R519","H539","Z13228","E785","M629","F1020","M5412","D509","E039","H5213","S51851A","W5501XA","L0390","L918","F411","D649","R42","M9901","S134XXA","M9902","M546","Z0001","H903","R6889","M2041","M2011","M25561","M7989","F17210","H8110","F32A","R4182","G8918","G5603","Z01812","F17200","Z01818","G9389","R110","R531","H9313","Z09","Z96652","S8992XA","M25511","M25562","F325","M19011","I6523","M542","F1010","K449","Z03818","J40","R062","R195","K920","K259","K3189","D62","K319","R079","R55","I493","I4519","I10","M549"],"date":["2024-01-24","2025-07-29","2024-01-10","2025-09-23","2025-02-05","2025-03-20","2025-01-15","2025-10-27","2025-10-27","2024-06-17","2024-11-19","2024-03-05","2024-04-10","2024-03-05","2025-07-22","2025-07-22","2024-06-25","2025-11-11","2024-06-25","2025-07-22","2025-10-29","2024-07-29","2025-05-02","2025-05-02","2025-05-02","2025-11-11","2025-11-11","2023-01-05","2025-10-27","2023-07-13","2023-07-13","2023-07-13","2023-07-13","2024-07-25","2025-09-11","2023-05-24","2024-08-26","2024-08-26","2023-12-21","2025-05-01","2025-05-01","2025-01-10","2024-01-10","2024-01-10","2024-01-10","2024-10-02","2023-12-21","2024-11-19","2023-12-21","2025-09-19","2024-12-29","2024-12-29","2024-12-29","2022-10-20","2022-10-20","2022-10-20","2022-09-20","2022-09-19","2022-07-21","2022-07-21","2022-07-12","2022-07-12","2022-07-08","2022-07-08","2022-06-17","2022-06-17","2022-06-17","2022-05-02","2022-05-02","2022-05-06","2022-05-06","2022-05-06","2022-05-06","2022-04-20","2022-04-13","2022-04-13","2022-04-13","2022-04-13","2022-04-12"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","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":""}]}]}