{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Arlene L Lambert","gend":1,"currentgend":"","add":"80 REBECCA LN","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1952-03-31","age":"","mstatus":"","insh":"10000054260","cliId":"","pno":2078359739,"cno":"","email":"","ename":"","eno":"","pphy":"PATCH, JEFFREY S","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":"80 REBECCA LN","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2078741483,"pcpnpi":1720067317,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5UP7WA9EY39","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R300","C719","G8194","S32592A","W19XXXA","R262","Z736","M62838","R339","F419","M7989","M810","Z0000","R482","R2681","M6281","M79641","M5441","M5431","M5450","L89151","M533","G43909","L820","G9341","J9601","S22070A","R6889","G43709","S32592D","S61459A","H40013","U071","R051","L400","S79912A","M25572","I6522","S299XXA","G4489","G40209","F32A","G40909","L570","L821","W5501XD","Z23","L89156","R059","M79672","F324","R000","K5900","Z9181","Z96642","R2689","M47816","G8911","S61451A","L89152","S32592S","M439","Z8659","Z7189","R791","S70912A","M79605","M8588","Z95828","I739","F331","S99912A","S93402A","Z471","H5340","Z48812","I6523","I6521","I959","N3281","N3941","K5904","R0781","E7800","F329","I2510","Z006","S72002D","S2239XA","R32","I6529","Z01812","Z96649","H539","M80052D","K5901","G40001","M25552","S72002A","G478","Z0100","H2513","C711","R0789","I779","I720","B351","I7389","L84","M79674","M79675","N644","R928"],"date":["2023-02-27","2025-09-29","2025-06-23","2023-02-23","2023-02-14","2023-02-14","2023-02-14","2023-02-23","2023-03-06","2023-03-06","2025-11-03","2025-02-03","2025-02-10","2023-08-10","2023-08-10","2023-08-10","2025-11-04","2024-04-24","2024-03-12","2024-03-12","2023-08-12","2023-08-12","2023-08-12","2024-08-14","2022-12-29","2023-01-04","2022-12-29","2023-12-11","2025-04-24","2023-02-01","2025-10-20","2025-05-05","2023-02-23","2023-01-10","2024-11-19","2022-12-25","2023-03-06","2023-04-25","2022-12-25","2025-09-29","2025-09-29","2025-03-20","2025-02-03","2023-11-21","2024-11-19","2025-11-03","2025-02-10","2023-08-12","2023-01-09","2023-04-07","2023-08-08","2023-03-06","2023-01-03","2023-08-08","2023-01-17","2022-12-01","2023-01-17","2023-01-17","2025-11-03","2023-08-08","2023-03-06","2023-01-16","2022-12-28","2025-09-29","2022-12-28","2022-12-24","2022-12-24","2024-08-19","2023-04-25","2022-08-01","2022-07-05","2022-06-18","2022-06-18","2022-06-18","2022-06-17","2022-05-08","2022-04-25","2022-04-13","2022-04-13","2022-04-15","2022-04-15","2022-04-15","2022-04-02","2022-03-30","2022-03-30","2022-03-30","2022-03-30","2022-03-09","2022-03-18","2022-03-18","2022-03-18","2022-03-27","2022-01-17","2021-11-22","2021-11-09","2021-12-07","2021-11-29","2022-02-11","2021-12-07","2021-12-07","2022-01-04","2022-01-04","2022-02-14","2022-01-24","2022-01-25","2022-01-25","2022-01-31","2022-01-31","2022-01-31","2022-01-31","2022-01-31","2022-02-16","2022-02-16"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CALCITONIN-SALMON","","","Select","Select",""],["","","DIVALPROEX SODIUM ER","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}