{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Suzanne R Dufresne","gend":1,"currentgend":"","add":"279 HAINES MEADOW RD","city":"BUXTON","state":"ME","zip":"04093","dob":"1948-09-08","age":"","mstatus":"","insh":"10000056234","cliId":"","pno":2072812234,"cno":"","email":"SDUFRESNE@ROADRUNNER.COM","ename":"","eno":"","pphy":"ACHILLE, JUSTINE","ppno":2078392559,"pcpadd":"Martins Point Health Care,PO Box 9746","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04104","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"279 HAINES MEADOW RD","madd2":"","madd3":"","mcity":"BUXTON","mstate":"ME","mzip":"04093","pcpfaxno":2075231135,"pcpnpi":1962962324,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7X34P65QA62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K626","K622","Z7901","Z8679","M5416","M5459","E785","I471","I480","D381","R059","I2510","Z853","Z9011","I088","I77810","I4710","I4892","M9905","R921","I491","I493","I440","M79672","R053","M2041","M7741","M79671","K623","E7800","M47816","M5126","R000","K5730","K6389","K5790","K649","K6289","H1131","J329","Z0101","R002","R519","R6889","R918","N6489","R92333","J8410","R911","C50111","M5450","M5136","R928","G43809"],"date":["2022-12-15","2022-12-15","2025-10-21","2025-08-19","2023-01-04","2023-01-04","2025-08-14","2023-09-01","2025-11-04","2024-11-15","2024-09-03","2023-09-01","2024-11-05","2025-11-14","2024-12-09","2024-12-09","2025-07-22","2024-12-09","2025-11-17","2023-11-01","2023-08-10","2023-08-10","2023-08-10","2023-01-26","2025-02-18","2023-01-26","2023-01-26","2023-01-26","2022-12-15","2025-03-18","2023-02-02","2023-02-02","2024-09-24","2022-12-15","2022-12-15","2022-12-15","2022-12-15","2022-12-15","2025-04-29","2025-01-17","2025-04-02","2024-03-30","2024-03-30","2023-01-26","2024-09-03","2025-11-14","2025-11-14","2023-11-07","2024-11-08","2022-10-26","2022-10-28","2022-10-28","2022-10-26","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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","DILTIAZEM HCL","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","CARTIA XT","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DABIGATRAN ETEXILATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PRALUENT PEN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MELOXICAM","","","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":""}]}]}