{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dawn M Trimm","gend":1,"currentgend":"","add":"132 CRAM ST","city":"BRADLEY","state":"ME","zip":"04411","dob":"1952-10-23","age":"","mstatus":"","insh":"10000056216","cliId":"","pno":2078278426,"cno":3212228376,"email":"KYAK77@AOL.COM","ename":"","eno":"","pphy":"JURGENS, PAUL J","ppno":2079412373,"pcpadd":"Northern Light Husson Family Medicine,302 Husson Ave Ste 2","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 198","madd2":"","madd3":"","mcity":"BRADLEY","mstate":"ME","mzip":"04411","pcpfaxno":2079418803,"pcpnpi":1629590484,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8G96GD9PA40","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40013","Z0101","R920","N6320","R92331","D485","L814","N6001","D509","N6313","M5136","K56600","Z8719","Z98890","Z8739","H40022","E119","N904","I10","Z862","M1990","L570","D225","L821","L853","L918","R208","L538","Z01411","B078","B3731","Z79899","H40023","H26491","Z1231","N6489","R0600","L292","N393","Z124","N6011","N816","N390","J45909","R058","R0602","M47816","M4316","R921","N762","R300","L304","Z0000","D649","R222","J189","R059","Z23","D1801","L728","R928","K5989","K5651","R1084","R112","K56609","K909","R1013","E860","R140","J9811","R0789","R0609","R7301","E213","M19042","R700","R079","K430","K219","K660","R030","R1011","K760","N838","R6889","I700","E6601","Z6841"],"date":["2023-12-06","2023-12-06","2025-11-10","2025-11-03","2024-10-29","2025-10-27","2025-10-27","2025-04-29","2024-05-15","2024-10-29","2024-05-15","2022-12-06","2024-04-08","2022-12-06","2022-12-06","2025-07-07","2025-10-30","2025-08-01","2025-10-30","2023-05-10","2023-05-10","2025-04-28","2025-04-28","2025-10-27","2025-04-28","2025-04-28","2025-04-28","2025-10-27","2023-05-16","2025-10-27","2025-08-01","2025-04-30","2024-07-08","2024-07-08","2023-04-24","2025-04-29","2023-11-22","2024-11-19","2024-11-19","2023-05-16","2023-09-12","2024-06-20","2024-06-20","2025-04-08","2025-04-08","2025-04-08","2024-05-15","2024-05-15","2024-04-29","2025-04-07","2025-04-07","2025-04-07","2023-11-10","2023-11-01","2024-04-29","2025-04-08","2025-04-08","2023-11-10","2025-10-27","2025-10-27","2025-11-03","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-28","2022-11-15","2022-10-25","2022-10-25","2022-10-27","2022-10-27","2022-10-18","2022-10-18","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-06","2022-06-17","2022-06-17","2022-06-17","2022-06-07","2022-05-03","2022-05-03","2022-05-03","2022-04-25","2022-04-21","2022-04-21","2022-04-21"],"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",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PFIZER 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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}