{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra Weston","gend":1,"currentgend":"","add":"523 BRICKETT POINT ESTS","city":"OAKLAND","state":"ME","zip":"04963","dob":"1946-05-26","age":"","mstatus":"","insh":"10000057513","cliId":"","pno":2078908241,"cno":"","email":"pandegrande@hotmail.com","ename":"","eno":"","pphy":"LEBLANC, CHRISTINA","ppno":2078731098,"pcpadd":"MaineGeneral Medical Center,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"THAYER INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"523 BRICKETT POINT ESTS","madd2":"","madd3":"","mcity":"OAKLAND","mstate":"ME","mzip":"04963","pcpfaxno":2078615461,"pcpnpi":1154773935,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9Q94D98QV83","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I2089","G4733","G4710","L820","D0439","M25559","I4891","E119","Z0000","L570","R0602","I10","Z7901","Z6833","M25512","I480","Z1231","Z780","H52223","H401232","Z961","H02831","Z0101","M436","I4811","R9431","D0461","D044","L579","Z85828","L821","D229","D485","M25551","M25552","M51369","I081","G4730","E785","D0462","H47233","C44629","Z01810","I119","D6869","M150","E6601","Z13820","Z23","D225","H401231"],"date":["2024-03-12","2025-11-09","2025-11-09","2024-04-09","2024-04-16","2025-06-06","2025-06-06","2025-06-06","2025-06-06","2024-11-19","2024-03-21","2024-04-25","2024-02-13","2024-02-13","2024-01-20","2025-02-19","2025-07-09","2025-07-09","2025-06-09","2025-06-09","2024-11-01","2023-06-22","2023-06-22","2025-02-17","2024-02-21","2024-02-21","2023-11-20","2023-11-20","2023-11-13","2023-11-13","2023-11-13","2023-11-13","2024-11-19","2025-06-06","2025-06-06","2025-06-06","2024-03-12","2024-04-25","2024-04-25","2025-01-13","2024-11-01","2024-11-19","2024-03-06","2024-10-30","2024-10-30","2024-10-30","2024-10-30","2022-10-28","2022-10-28","2022-11-15","2022-10-17"],"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":[["","","LATANOPROST","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","TIADYLT ER","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}