{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anne M Chase","gend":1,"currentgend":"","add":"24 MEADOW HILL DR","city":"FARMINGDALE","state":"ME","zip":"04344","dob":"1949-03-25","age":"","mstatus":"","insh":"10000059998","cliId":"","pno":2076234608,"cno":"","email":"groycec@me.com","ename":"","eno":"","pphy":"HOKE, ABIGAIL","ppno":2075826608,"pcpadd":"Gardiner Family Medicine,5 Central Maine Crossing","pcpcity":"Gardiner","pcpstate":"ME","pcpzip":"04345","pcpcounty":"","pcpid":"","pcpname":"GARDINER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 MEADOW HILL DR","madd2":"","madd3":"","mcity":"FARMINGDALE","mstate":"ME","mzip":"04344","pcpfaxno":2075822258,"pcpnpi":1740576495,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1F20WY9KH27","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1231","R92323","E876","M25511","R296","R2681","R1110","S3991XA","R109","K56609","Z9049","R490","R9089","G9389","G309","G319","Z98890","I700","K50012","K5090","G4733","G300","Z0001","G301","K56600","R262","M542","S0101XA","Z9089","Z90710","F0280","M9903","M47816","M9902","M47814","Z8719","G40009","K5000","G3184","I673","F0154","G43109","R2689","R110","Z043","F02A3","F01A3","G40909","K5900","K0889","W108XXS","R197","Z0000","R4189","D3132","Z0100","F331","F418","R112","E162","I493","Z4802","M25462","M25562","Z09","L03116","R9401","G40209","J189","D225","L814","L649","N390","Z789","Z9181","I10","R1084","R918","Z79899","N6342","R928","M9901","M47812","R419","F419","R6889"],"date":["2025-11-12","2025-11-12","2025-05-13","2023-02-01","2025-11-19","2025-11-19","2025-03-23","2024-04-29","2025-05-05","2025-01-23","2025-01-23","2023-10-13","2024-09-24","2024-09-24","2025-10-09","2024-09-24","2024-04-26","2025-05-05","2025-02-26","2025-11-05","2025-03-14","2025-11-04","2025-03-12","2025-07-22","2023-05-17","2025-08-19","2025-09-05","2025-09-05","2025-05-05","2025-05-05","2025-10-09","2024-09-17","2024-09-17","2024-09-17","2024-09-17","2025-02-26","2025-10-09","2025-03-28","2024-01-26","2025-01-15","2025-01-15","2025-01-15","2025-10-09","2025-05-13","2025-09-05","2025-07-22","2025-07-22","2025-07-22","2025-05-13","2024-11-17","2024-09-12","2025-05-19","2023-05-30","2024-02-05","2025-01-20","2025-01-20","2023-05-30","2023-05-30","2025-04-02","2025-03-24","2025-02-17","2025-09-19","2024-12-31","2024-12-31","2024-05-03","2024-12-31","2024-01-22","2024-09-23","2024-04-30","2023-10-30","2023-10-30","2023-10-30","2025-10-10","2025-03-13","2023-08-29","2024-12-12","2024-04-26","2024-04-27","2025-11-05","2022-10-10","2022-10-10","2022-09-21","2022-09-21","2022-09-14","2022-09-14","2022-08-19"],"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":[["","","LACOSAMIDE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","RIVASTIGMINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DIVALPROEX SODIUM ER","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ZYMFENTRA PEN (2 PACK)","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","BRIVIACT","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","DIVALPROEX SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ZONISAMIDE","","","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":""}]}]}