{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Judith A Curtis","gend":1,"currentgend":"","add":"484 SUNSHINE RD","city":"DEER ISLE","state":"ME","zip":"04627","dob":"1952-04-15","age":"","mstatus":"","insh":"10000054538","cliId":"","pno":2076649881,"cno":"","email":"Judycurtis0415@gmail.com","ename":"","eno":"","pphy":"BUGBEE, THOMAS H","ppno":2074697371,"pcpadd":"Bucksport Regional Health Center,37 Commerce Park","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"BUCKSPORT REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 362","madd2":"","madd3":"","mcity":"DEER ISLE","mstate":"ME","mzip":"04627","pcpfaxno":2073743981,"pcpnpi":1326082405,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8P33U42DJ00","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S20364A","M810","C50212","M25559","M2560","N6489","C50412","Z170","M1612","R922","N6452","Z853","Z471","Z96642","R920","Z510","N6325","F5101","Z1722","Z1732","K921","Z0000","M9906","M25572","M25552","M9905","M1611","M1711","L570","L578","L821","D1801","L814","S61412A","W540XXA","Z8781","Z01818","Z483","I340","E785","F418","M47816","C50812","Z79811","M8580","Z0100","M1712","C50912","Z01411","M85852","F411","M8589","M160","R6889","S61512D","W540XXD","F410","N6321","R011","Z87891","Z8042","M25551","Z1721","Z1151","Z01419","S62102D","Z23","M2550","R87810","B977","R92332","S52592D","Z1231","Z872","B009"],"date":["2022-10-17","2024-09-26","2025-06-13","2024-04-05","2024-04-05","2025-09-03","2025-03-13","2025-05-21","2024-06-28","2022-10-21","2025-05-28","2025-05-28","2025-07-02","2025-07-02","2024-10-23","2025-02-05","2024-09-30","2023-06-02","2025-03-13","2025-05-21","2023-05-25","2025-07-08","2023-12-06","2023-12-06","2023-12-19","2023-12-06","2025-07-02","2025-07-02","2025-04-18","2025-04-18","2025-04-18","2023-10-16","2023-10-16","2022-10-18","2022-10-18","2022-10-18","2024-05-21","2024-12-09","2024-06-28","2024-06-28","2024-06-28","2024-05-01","2024-11-19","2025-06-13","2025-06-13","2024-10-28","2024-02-26","2025-09-03","2023-06-26","2022-10-17","2025-03-21","2024-09-04","2024-08-02","2023-11-11","2022-10-25","2022-10-25","2025-03-21","2024-09-30","2024-06-28","2024-11-19","2024-12-26","2024-03-27","2025-05-21","2023-06-26","2023-06-26","2022-10-18","2024-10-09","2025-03-12","2023-06-26","2023-06-26","2025-05-28","2022-10-18","2022-10-17","2025-05-29","2022-08-08"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","ANASTROZOLE","","","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":""}]}]}