{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dorothy L Gilchrest","gend":1,"currentgend":"","add":"43 GILLANDER AVENUE","city":"AUBURN","state":"ME","zip":"04210","dob":"1953-04-08","age":"","mstatus":"","insh":"10000060052","cliId":"","pno":2075771428,"cno":"","email":"d.gilchrest@hotmail.com","ename":"","eno":"","pphy":"HARRIS, JAMES V","ppno":2078346140,"pcpadd":"NMMC Medical Practices,194 E Main St","pcpcity":"Fort Kent","pcpstate":"ME","pcpzip":"04743","pcpcounty":"","pcpid":"","pcpname":"NMMC MEDICAL PRACTICES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"43 GILLANDER AVENUE","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":2078344451,"pcpnpi":1316936644,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9K05UE8PX77","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1612","I471","G5601","G5621","M1811","R52","J189","R300","G4710","J4530","G4730","J989","R7301","Z0000","E662","I25110","J40","E119","Z780","Z130","R0600","U071","R059","K449","I700","J9811","J309","E7800","K862","M549","M25552","R0602","R0781","R7303","Z1231","R202","M25559","N3001","Z0101","R7309","H35372","H2513","R6889","Z1211","H25811","H2512","I440","I480","R7989","H3563","B9689","G4733","Z981","E785","J45909","I10","E669","Z8249","Z01419","R21","I351"],"date":["2023-05-19","2023-09-22","2023-06-02","2023-06-02","2024-01-23","2023-06-02","2025-09-10","2025-06-26","2024-06-05","2024-06-05","2024-06-05","2023-03-05","2023-06-06","2024-02-02","2025-02-06","2023-08-28","2025-08-22","2025-08-22","2024-03-12","2025-02-07","2023-06-06","2023-06-06","2025-08-22","2023-03-03","2023-03-03","2023-03-03","2023-06-13","2024-12-19","2024-08-12","2024-02-08","2022-12-06","2023-03-03","2023-03-03","2023-06-13","2025-03-27","2023-05-19","2023-03-02","2025-08-05","2025-04-02","2024-03-21","2025-04-02","2024-03-21","2023-03-20","2025-11-10","2025-04-02","2025-04-02","2023-09-11","2025-01-07","2023-06-13","2023-03-20","2025-08-05","2022-11-23","2022-10-31","2022-08-11","2022-07-22","2022-07-06","2022-07-06","2022-06-22","2022-06-02","2022-06-02","2022-06-02"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","CAPVAXIVE","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","PRALUENT PEN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","TRUEPLUS PEN NEEDLE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}