{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan D Richard","gend":1,"currentgend":"","add":"84 CHASE BROOK DR","city":"BAILEYVILLE","state":"ME","zip":"04694","dob":"1953-04-27","age":"","mstatus":"","insh":"10000060079","cliId":"","pno":2072149514,"cno":"","email":"susanrichard71@gmail.com","ename":"","eno":"","pphy":"RUSSELL, JACQUELINE","ppno":"","pcpadd":"CCH Family Medicine,37 Palmer St Ste 3","pcpcity":"Calais","pcpstate":"ME","pcpzip":"04619","pcpcounty":"","pcpid":"","pcpname":"CCH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"84 CHASE BROOK DR","madd2":"","madd3":"","mcity":"BAILEYVILLE","mstate":"ME","mzip":"04694","pcpfaxno":"","pcpnpi":1730742107,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6K56Q51YC74","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E8342","M7989","Z1272","D485","D225","L814","L821","L218","M25561","R918","R42","Z20822","J069","G4700","R5382","Z09","Z96651","B3732","N3090","N7689","E785","H903","H6123","Z124","Z79890","N952","R6889","R059","L659","H04123","H2513","Z1231","N390","M2550","Z1211","N3001","H8110","R682","M7631","I10","E079","Z7189","L820","L538","L298","Z789","R350","R3915","F418","J209","N898","B3731","R739","R300","H7402","B373","D2372"],"date":["2024-07-24","2025-02-18","2024-10-30","2024-07-30","2025-07-31","2025-07-31","2025-07-31","2025-07-31","2025-02-18","2022-10-07","2022-10-07","2024-08-19","2024-08-19","2025-01-29","2025-01-09","2024-05-22","2024-05-22","2023-10-26","2023-03-21","2023-03-21","2023-10-20","2025-07-10","2024-12-20","2024-10-30","2024-10-30","2024-10-30","2023-02-08","2023-12-14","2025-06-04","2025-04-03","2025-04-03","2025-03-04","2022-11-21","2023-02-16","2024-09-25","2022-10-07","2022-10-07","2023-02-16","2025-04-14","2024-01-16","2025-05-20","2025-06-20","2023-02-09","2023-02-09","2023-02-09","2023-02-09","2023-03-21","2023-03-21","2024-08-27","2024-08-27","2024-10-04","2022-10-12","2022-12-21","2023-02-28","2022-11-07","2022-09-21","2022-08-15"],"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":[["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","VASCEPA","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","AIRSUPRA","","","Select","Select",""],["","","TERCONAZOLE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","PREVIDENT 5000 DRY MOUTH","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","ICOSAPENT ETHYL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}