{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia A Peard","gend":1,"currentgend":"","add":"9 GRANITE RIDGE RD","city":"CUMBERLAND FORESIDE","state":"ME","zip":"04110","dob":"1946-03-28","age":"","mstatus":"","insh":"10000061188","cliId":"","pno":2078313676,"cno":"","email":"","ename":"","eno":"","pphy":"CATHCART, WENDY","ppno":2077745816,"pcpadd":"Intermed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9 GRANITE RIDGE RD","madd2":"","madd3":"","mcity":"CUMBERLAND FORESIDE","mstate":"ME","mzip":"04110","pcpfaxno":2078741483,"pcpnpi":1295704971,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9UM5F88YX75","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R197","Z48815","K625","K6030","K6289","K5900","E785","R7303","E039","K649","R4182","Z0001","K642","Z0101","H35371","R195","D492","K610","H26493","Z23","K603","Z7189","K648","Z1231","R053","R051","S61032A","W5501XA","L718","L821","H6122","C44311","L820","D225","Z85828","Z87891","M8588","L720","H2513","H2511","H259","H2512","H52222","N200","H25813","H3554","Z0000","N393","N281"],"date":["2024-01-09","2025-04-08","2025-06-13","2025-02-07","2025-06-13","2025-06-05","2025-10-31","2024-10-28","2025-10-31","2024-09-09","2025-02-07","2025-11-07","2025-02-07","2025-10-20","2025-10-20","2024-01-09","2025-09-17","2024-10-03","2023-02-15","2025-10-14","2024-09-09","2024-11-04","2024-09-09","2024-02-05","2025-01-06","2024-12-19","2023-11-20","2023-11-20","2023-03-28","2023-03-28","2023-11-04","2025-09-17","2025-05-01","2024-09-24","2024-09-09","2024-09-09","2022-10-27","2022-09-20","2022-07-28","2022-06-27","2022-06-27","2022-06-13","2022-06-13","2022-06-17","2021-10-14","2021-10-14","2022-01-21","2022-02-02","2022-02-02"],"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":[["","","POTASSIUM CITRATE ER","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","VANCOMYCIN HCL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","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":""}]}]}