{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lynne M Smith","gend":1,"currentgend":"","add":"5 FIELDCREST DR","city":"Saco","state":"ME","zip":"04072","dob":"1951-08-01","age":"","mstatus":"","insh":"10000057620","cliId":"","pno":2077454852,"cno":"","email":"lms1991ena@roadrunner.com","ename":"","eno":"","pphy":"CUTONE, JENNIFER A","ppno":2074673200,"pcpadd":"Internal Medicine of Southern Maine,2 Independence Dr Ste B","pcpcity":"Kennebunk","pcpstate":"ME","pcpzip":"04043","pcpcounty":"","pcpid":"","pcpname":"INTERNAL MEDICINE OF SOUTHERN MAINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 FIELDCREST DR","madd2":"","madd3":"","mcity":"Saco","mstate":"ME","mzip":"04072","pcpfaxno":2074673207,"pcpnpi":1003879909,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6QD0UR0GU26","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1211","E039","I10","E785","N1830","J320","G4733","D485","M25511","R1312","Z0000","Z23","M79601","K219","E669","R4182","Z4802","M7062","C44519","Z803","Z780","M5459","Z79899","M353","M2550","R0683","D801","F419","F32A","J329","H2511","R21","H2512","S62347A","N644","M069","M5450","G8929","R059","R1310","Z6834","R1314","H2513","H18593","D518","K5900","J0140","M810","R911","R7301","D7589","Z8371","M67919","R200","H16223","M79603","M79641","R1013","R112","H52213","S62347D","R771","Z1231","M7061","M329","Z6833","M7601","M1611","R197","N289","Z0101","R0602","F418","R58","R6889","M79645","W109XXA","R928","M6281","E559"],"date":["2023-01-24","2025-06-25","2025-06-25","2025-06-25","2025-06-25","2024-09-06","2025-05-01","2025-07-21","2025-02-03","2024-05-24","2023-12-12","2024-09-25","2025-01-28","2024-05-24","2024-02-15","2024-05-24","2025-08-21","2025-09-15","2025-08-07","2024-02-15","2024-02-27","2024-06-13","2025-10-24","2024-04-30","2024-09-20","2024-11-17","2023-12-01","2023-12-01","2024-01-05","2024-02-26","2025-04-01","2025-06-20","2025-03-25","2023-10-05","2023-01-06","2025-10-24","2024-02-06","2024-02-06","2025-10-15","2024-05-24","2024-02-27","2024-05-24","2025-01-24","2025-01-24","2024-04-12","2024-02-27","2024-12-06","2024-02-27","2023-10-06","2025-06-13","2024-12-10","2023-01-24","2025-01-28","2025-01-28","2025-01-24","2024-10-30","2024-10-30","2023-05-19","2023-05-19","2025-01-24","2023-11-07","2024-12-10","2025-08-21","2024-01-16","2023-07-21","2025-04-25","2024-03-27","2024-03-27","2023-05-19","2023-05-26","2024-02-22","2023-09-12","2023-08-31","2023-08-31","2023-01-04","2023-08-20","2023-08-20","2023-01-06","2024-10-30","2022-11-22"],"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":[["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","SODIUM FLUORIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)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":""}]}]}