{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra A Levasseur","gend":1,"currentgend":"","add":"26 GARNETT AVE","city":"LEWISTON","state":"ME","zip":"04240","dob":"1951-07-15","age":"","mstatus":"","insh":"10000058789","cliId":"","pno":2075768098,"cno":"","email":"slevasseur16@gmail.com","ename":"","eno":"","pphy":"TAN, EDWIN V","ppno":2073303950,"pcpadd":"PO BOX 7291,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"AUBURN MEDICAL ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"26 GARNETT AVE","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":2073303955,"pcpnpi":1629074240,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7CU9PC5CQ16","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":["Z0000","M1712","M170","M25512","M7061","M25551","M1611","Z6835","F1199","Z0101","S99922A","Z471","Z96641","Z01818","G8929","D62","I10","E785","S92352A","Z1231","Z780","M7522","E7800","M79672","R29898","I7789","Z98890","M19012","Z01812","S92352S","M12851","R600","J069","M1990","S62307A","E669","R4182","J0190","B3731","B9689","G629","G894","T753XXS","R52","Z1211","F419","M792","F32A","S92352D","L309","M1711","Z0189","S92901S","R5383","R252","K219","E559","G479","M62838","S92902S"],"date":["2025-04-23","2024-03-13","2023-09-28","2025-10-31","2025-02-05","2024-05-01","2024-10-24","2024-06-21","2025-10-16","2024-09-16","2023-11-27","2024-12-04","2025-03-12","2023-12-04","2025-04-16","2024-10-24","2024-10-24","2024-10-24","2023-12-06","2025-10-27","2025-10-27","2025-11-17","2025-06-27","2024-02-14","2025-10-31","2025-10-31","2025-01-03","2025-10-16","2024-10-09","2023-12-06","2024-08-29","2024-08-29","2023-02-06","2023-09-20","2023-12-06","2024-10-24","2024-10-24","2023-02-17","2023-02-17","2023-02-17","2023-06-13","2023-06-13","2023-06-13","2024-05-01","2024-04-15","2023-04-12","2023-04-12","2023-04-12","2023-12-20","2022-09-14","2022-07-29","2022-06-09","2021-12-15","2022-02-11","2022-02-11","2022-01-20","2022-02-11","2022-02-24","2022-02-24","2022-02-24"],"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":[["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DICLOFENAC SODIUM ER","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","FLUBLOK TRIVALENT 2024-2025","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2021-22","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","VENLAFAXINE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}