{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Candace G Wheelden","gend":1,"currentgend":"","add":"423 TOPAZ DR","city":"South Portland","state":"ME","zip":"04106","dob":"1952-02-14","age":"","mstatus":"","insh":"10000054613","cliId":"","pno":2072198521,"cno":"","email":"","ename":"","eno":"","pphy":"DOBIESKI, STEVEN T","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"423 TOPAZ DR","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":2078741483,"pcpnpi":1942279617,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3MX6PA3KW64","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N201","R0609","L570","L989","L309","L819","R234","M25551","D485","Z85828","L821","C4492","M79651","M79652","E039","E1136","N179","N200","J029","C44729","D489","R21","Z1231","Z5189","N8110","I129","E1122","R5383","R112","Z98890","L511","L820","Z23","Z0000","E1121","E1159","E1169","Z1211","E1129","Z0100","N1831","C44722","C44329","N132","E870","D72829","R944","R8290","E7800","L513","F32A","T148XXA","D0471","L308","Z0001","R1033","S5011XA","E119","I10","D225","R809","M20012","M25642","M79642","R600","J020","Z20822","Z03818","K120","L900"],"date":["2023-08-28","2024-06-03","2025-06-11","2025-03-21","2025-03-21","2025-03-21","2025-03-21","2024-06-03","2024-04-22","2025-03-12","2025-11-04","2025-03-26","2025-04-07","2025-04-07","2025-07-08","2025-04-07","2025-04-07","2023-09-08","2023-11-13","2025-03-31","2025-11-04","2025-03-26","2024-06-29","2023-08-16","2023-09-08","2023-08-28","2023-08-28","2025-07-22","2023-08-28","2023-08-28","2025-03-20","2023-11-29","2024-12-09","2024-12-09","2024-06-03","2023-06-30","2025-07-08","2025-06-30","2023-06-30","2025-01-30","2025-07-08","2025-03-31","2023-05-10","2023-08-03","2025-07-08","2023-08-03","2023-08-03","2023-08-03","2025-01-08","2025-03-22","2025-03-22","2025-06-11","2024-06-04","2024-12-04","2022-12-02","2022-12-02","2022-10-26","2022-10-26","2022-10-26","2022-08-03","2022-06-21","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-12-10","2021-12-10","2022-01-27","2022-01-28","2022-01-28"],"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":[["","","HALOBETASOL PROPIONATE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","GENTAMICIN SULFATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}