{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michele V Vachon","gend":1,"currentgend":"","add":"2 BREEANN DRIVE","city":"LISBON","state":"ME","zip":"04250","dob":"1954-06-04","age":"","mstatus":"","insh":"10000058527","cliId":"","pno":2075772734,"cno":"","email":"michelevvachon@gmail.com","ename":"","eno":"","pphy":"LITTLE, KASEY R","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2 BREEANN DRIVE","madd2":"","madd3":"","mcity":"LISBON","mstate":"ME","mzip":"04250","pcpfaxno":2078741483,"pcpnpi":1720441595,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1EE4NR1FM81","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R519","J3489","M7741","D2371","J069","M810","M5013","M25531","M25641","M05741","M79644","L820","L2989","Z789","R208","G43719","M19011","M7521","D509","K2980","K3189","D123","K5790","K648","M47812","R109","Z1231","Z0101","H2513","H16223","R6889","M47816","M0579","M1811","R102","E039","J4520","Z9109","M25512","J45909","J4521","T486X5A","R000","I10","M47817","M301","G8918","S46011A","K219","M069","G4489","M797","M7522","R051","R059","M5033","M5136","M51360","Z0001","J029","K769","K635","R110","R898","M75121","M67911","Z23","Z0000","R140","K589","J340","M7551","M7541","M25511","H90A32","H90A11","B009","R918","M4802","M4722","M4312","M7072","K838","R932","H900","R5383","N898","M542","J45901","H6993","R300","D7210","K2950","F5101","L298","M25552","M5030","M25532","M150","G8929","J329","D649","G4701","M67813","N2889","K7689","K1379","J310","M25571","M818","J929","L821","L814","L818","M8589","J441","Z79899","B078","Z08","Z1211","M5450","R221","R222","M75101","J309","L299","J3081","J301","G43909","Z87891","J0190","U071"],"date":["2024-03-08","2025-11-06","2025-02-21","2025-02-21","2025-06-22","2025-08-29","2023-11-29","2025-08-29","2025-08-21","2025-08-21","2025-08-21","2025-04-22","2025-04-22","2025-04-22","2025-04-22","2025-10-03","2024-03-04","2025-01-14","2023-04-20","2023-04-20","2023-04-20","2023-04-20","2023-04-20","2023-04-20","2025-05-13","2023-07-26","2025-04-18","2025-02-20","2025-02-20","2025-02-20","2023-08-11","2025-04-30","2025-08-29","2023-04-26","2024-02-08","2025-10-10","2024-03-04","2024-03-04","2024-03-04","2025-11-06","2022-11-30","2022-11-30","2022-11-30","2025-10-22","2025-07-22","2024-11-20","2023-03-02","2023-03-02","2023-03-02","2024-02-08","2024-02-08","2024-02-08","2024-12-13","2024-03-18","2025-06-22","2025-04-24","2023-12-05","2025-04-24","2025-05-08","2023-02-17","2023-08-07","2023-04-20","2023-04-20","2024-03-15","2023-10-18","2025-01-14","2025-10-22","2023-07-31","2023-06-06","2023-05-25","2024-12-10","2023-03-02","2023-03-02","2024-03-04","2024-03-05","2024-03-05","2023-08-16","2023-09-27","2024-07-03","2024-07-03","2024-07-03","2024-06-12","2023-08-07","2023-08-07","2025-08-13","2025-07-22","2023-09-06","2024-07-03","2025-06-22","2024-01-18","2024-01-31","2024-12-04","2023-05-09","2023-05-05","2024-09-24","2024-05-23","2024-05-23","2025-08-29","2023-10-30","2023-12-28","2024-03-05","2023-04-03","2024-09-25","2025-01-08","2023-07-06","2023-07-06","2025-10-22","2024-12-04","2025-01-17","2025-10-22","2023-09-27","2023-09-20","2023-09-20","2023-09-20","2025-04-03","2022-11-22","2022-10-24","2022-11-16","2022-09-14","2022-09-21","2022-08-17","2022-07-20","2022-07-20","2022-06-28","2022-05-31","2022-05-24","2022-05-24","2022-05-24","2022-04-05","2022-03-24","2022-01-25","2022-01-26"],"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":[["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","LEVALBUTEROL TARTRATE HFA","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","DUPIXENT PEN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","DUPIXENT SYRINGE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","FENTANYL","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","AJOVY AUTOINJECTOR","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","NURTEC ODT","","","Select","Select",""],["","","ELETRIPTAN HBR","","","Select","Select",""],["","","RIZATRIPTAN","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN","","","Select","Select",""],["","","ALREX","","","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":""}]}]}