{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pamela J Belanger","gend":1,"currentgend":"","add":"563 EASTERN AVE","city":"Augusta","state":"ME","zip":"04330","dob":"1961-01-29","age":"","mstatus":"","insh":"10000055385","cliId":"","pno":2076232245,"cno":"","email":"jeffreylbelanger@gmail.com","ename":"","eno":"","pphy":"MURPHY, ROCHELLE S","ppno":2076243800,"pcpadd":"Winthrop Family Medicine,149 Main St","pcpcity":"Winthrop","pcpstate":"ME","pcpzip":"04364","pcpcounty":"","pcpid":"","pcpname":"WINTHROP FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"563 EASTERN AVE","madd2":"","madd3":"","mcity":"Augusta","mstate":"ME","mzip":"04330","pcpfaxno":2076243845,"pcpnpi":1245585108,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6H50YK7DA44","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47411","F419","N763","G43909","R61","L900","K219","R911","M9901","M542","M9902","M546","F32A","N9089","N898","R918","M810","D649","M7910","G47419","M2550","R1310","K2950","F418","R413","A689","Z0000","N904","N951","R6889","N83291","N1831","R438","J3489","R531","E785","M8580","R52","Z872","Z808","G8929","L309","G43719","M5450","R251","R509","R1011","R002","R5383","G588","Z1231","Z6379","G6289","G6181","R519","S62646A","I10","R202","S92514A","M7751","W230XXA","R102","K5909","Z780","G2581","N952","Z01419","Z1151","N762","R059"],"date":["2025-03-24","2023-05-17","2024-02-07","2025-05-09","2025-10-20","2023-05-22","2025-09-30","2025-10-23","2024-05-06","2024-05-06","2024-05-06","2024-05-06","2023-03-21","2023-07-18","2023-07-18","2025-10-23","2024-01-16","2025-07-24","2023-09-06","2023-03-21","2024-09-05","2024-10-24","2024-10-24","2023-01-23","2025-09-09","2025-07-09","2025-04-01","2023-05-25","2023-05-25","2023-12-15","2025-11-03","2025-07-09","2023-09-06","2023-09-06","2025-10-20","2025-01-28","2023-10-13","2023-10-12","2023-10-12","2023-10-12","2025-07-07","2023-05-22","2025-09-09","2024-08-27","2024-09-19","2025-10-20","2025-05-14","2025-02-25","2025-02-25","2024-01-17","2025-05-19","2022-12-14","2025-09-09","2025-05-09","2024-08-01","2024-06-19","2025-10-10","2025-06-02","2024-06-19","2024-06-19","2024-06-19","2024-07-31","2025-09-30","2023-12-06","2022-09-21","2022-09-30","2022-09-30","2022-09-30","2022-08-10","2022-08-10"],"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":[["","","LINZESS","","","Select","Select",""],["","","AJOVY AUTOINJECTOR","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SUNOSI","","","Select","Select",""],["","","WAKIX","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AIMOVIG AUTOINJECTOR","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","RIZATRIPTAN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FLUCONAZOLE","","","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":""}]}]}