{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan T Guenette","gend":1,"currentgend":"","add":"850 SAWYER RD","city":"GREENE","state":"ME","zip":"04236","dob":"1952-10-05","age":"","mstatus":"","insh":"10000056720","cliId":"","pno":2073754496,"cno":"","email":"","ename":"","eno":"","pphy":"WYMAN, PEGGY","ppno":2076472311,"pcpadd":"180 CHURCH HILL RD STE 1,","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"850 SAWYER RD","madd2":"","madd3":"","mcity":"GREENE","mstate":"ME","mzip":"04236","pcpfaxno":2075242093,"pcpnpi":1073592283,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4JX6M32NW83","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F329","Z1329","I110","I509","R791","R000","I4892","I214","I10","G4733","R0600","E038","I2510","E119","L859","Z01810","R9431","R9439","I447","Z713","L570","L821","L814","H26492","M25561","M25562","G8929","M65332","R7989","Z1231","Z01818","E782","I5032","Z7689","K219","Z0101","Z9841","Z9842","H43813","E559","M8589","I499","R0609","E6601","Z0184","M85852","Z09","E66812","M1990","L304","Z136","M7531","M7521","E66811","M19011","M19042","L259","M1712","M170","N390","Z0000","E785","R7302","R300"],"date":["2024-05-23","2025-06-18","2024-03-11","2024-08-14","2024-03-11","2024-03-11","2024-12-05","2024-03-13","2025-11-11","2025-10-14","2024-03-11","2025-06-17","2025-09-15","2025-11-11","2024-08-14","2023-03-14","2024-03-11","2024-11-08","2024-03-11","2023-08-28","2025-01-29","2025-01-29","2025-01-29","2023-04-12","2023-03-01","2023-02-22","2023-02-01","2025-01-03","2024-07-29","2025-01-09","2023-04-25","2025-11-11","2025-09-15","2023-08-02","2023-04-25","2025-05-05","2025-05-05","2025-05-05","2024-04-30","2025-05-27","2024-06-11","2024-06-05","2023-03-14","2024-11-08","2024-05-24","2024-06-11","2024-03-26","2025-02-17","2023-08-02","2024-01-29","2022-12-03","2023-11-24","2023-11-24","2025-11-11","2023-11-24","2024-11-14","2023-12-06","2023-01-20","2023-01-20","2022-11-07","2022-11-07","2022-11-07","2022-04-12","2022-04-12"],"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":[["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ACCU-CHEK GUIDE ME GLUCOSE MTR","","","Select","Select",""],["","","UNILET LANCETS","","","Select","Select",""],["","","ACCU-CHEK GUIDE TEST STRIP","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LANCING DEVICE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","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":""}]}]}