{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean K Burton","gend":1,"currentgend":"","add":"10 BEA LN","city":"CUMBERLAND CENTER","state":"ME","zip":"04021","dob":"1952-06-15","age":"","mstatus":"","insh":"10000055599","cliId":"","pno":2073184848,"cno":"","email":"Jean.burton@gmail.com","ename":"","eno":"","pphy":"MURRAY PULSIFER, KRISTY A","ppno":2078741489,"pcpadd":"InterMed,100 Foden Rd Ste 203","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 BEA LN","madd2":"","madd3":"","mcity":"CUMBERLAND CENTER","mstate":"ME","mzip":"04021","pcpfaxno":2078741483,"pcpnpi":1356310098,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8VY5PE4PC99","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1231","F331","R109","M546","S6992XA","E039","L821","S22070A","I10","Z0100","H353131","N281","K635","Z1211","M25551","E785","Z0001","R053","K219","K449","M25541","R7309","Z23","Z0000","R1310","K2090","L570","K5730","S62647A","S22000G","D120","H02831","H02834","D23111","K562","M79645","M79641","M47814","M419"],"date":["2025-04-29","2025-09-22","2023-11-06","2025-07-05","2024-03-07","2024-09-01","2024-11-09","2025-11-06","2023-04-17","2025-08-05","2025-08-05","2023-11-08","2023-12-20","2023-12-20","2025-01-13","2024-09-01","2025-11-11","2025-02-18","2025-02-18","2025-06-02","2024-12-09","2023-07-17","2025-10-15","2023-07-21","2025-06-02","2025-06-02","2023-10-13","2023-11-06","2024-03-07","2025-09-12","2023-12-20","2024-05-28","2024-05-28","2024-05-28","2023-12-20","2024-04-05","2024-04-05","2025-07-05","2025-07-05"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","EUTHYROX","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LISDEXAMFETAMINE DIMESYLATE","","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","VYVANSE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":""}]}]}