{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Doris Y Baxter","gend":1,"currentgend":"","add":"74 KING RD","city":"LISBON","state":"ME","zip":"04250","dob":"1953-08-06","age":"","mstatus":"","insh":"10000060988","cliId":"","pno":2072409910,"cno":"","email":"","ename":"","eno":"","pphy":"SALKO, DAVID L","ppno":2077986200,"pcpadd":"4 HORTON PL,STE. 101","pcpcity":"TOPSHAM","pcpstate":"ME","pcpzip":"40861747","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"74 KING RD","madd2":"","madd3":"","mcity":"LISBON","mstate":"ME","mzip":"04250","pcpfaxno":2077986290,"pcpnpi":1659338879,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3GR0M96FR05","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F17200","D485","L820","R208","F17210","L814","D2262","D2261","Z08","I639","L570","N132","N281","K760","M47816","K635","K5989","R197","I10","H6091","F17290","Z87891","M51362","M4725","Z1231","C44529","C44729","D0472","R195","E70318","G250","L905","N1830","M51370","M47817","M4316","C4442","D0471","L989","H3530","F419","Z0000","L723","M5126","M5136","N200","K5730","K6289","K5520","F329","E785","C44722","Z789","L858","I7143","N201","T887XXA","M5459","R350","C44629","Z01818","C44622","D0461","F411","L538","U071","L821","L720","Z7689","Z79899","R6889","L819"],"date":["2024-02-12","2025-06-25","2025-01-08","2025-09-17","2025-03-17","2025-06-25","2025-06-25","2025-06-25","2025-06-25","2024-08-20","2025-09-17","2023-12-12","2023-12-12","2023-12-12","2025-10-08","2025-03-21","2025-02-21","2025-04-08","2025-03-04","2024-09-03","2023-02-24","2025-04-02","2025-11-19","2025-11-19","2025-11-05","2023-06-21","2025-04-09","2023-06-21","2025-01-24","2025-08-29","2025-09-10","2023-01-06","2025-09-17","2025-10-08","2025-10-08","2025-10-08","2025-06-25","2025-06-25","2025-06-25","2024-08-08","2024-05-16","2024-07-02","2025-09-17","2023-08-18","2023-08-18","2025-02-27","2025-03-21","2025-03-21","2025-03-21","2024-05-16","2025-03-04","2023-10-25","2023-02-22","2023-06-21","2024-02-27","2024-02-27","2025-02-24","2025-10-08","2023-12-13","2023-10-25","2024-01-22","2024-10-18","2024-07-09","2025-03-04","2025-01-08","2022-12-02","2024-10-18","2025-09-17","2022-11-23","2022-11-23","2022-08-31","2022-08-24"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","IMIQUIMOD","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","PRIMIDONE","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","PEG3350-SOD SUL-NACL-KCL-ASB-C","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}