{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Constance L Quigley","gend":1,"currentgend":"","add":"24 ARLINGTON RD","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1953-04-24","age":"","mstatus":"","insh":"10000062000","cliId":"","pno":2076321501,"cno":"","email":"connieq24@gmail.com","ename":"","eno":"","pphy":"EDWARDS, CHRISTINA S","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 700","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":"24 ARLINGTON RD","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2075238597,"pcpnpi":1326334335,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1ME3K61GM71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z808","Z0100","H35373","Z1231","D485","D224","L820","Z96641","L578","L821","D225","M1611","M47816","M5431","L570","R61","E7800","I10","D2261","C4481","Z471","C4441","D492","M1612","E785","N8189","R32","M25552","Z0000","G2581","R5383","M1990","Z01812","H00011","S90222A","D692","Z85828","Z08","M25551","Z853","Z9011","Z780","M48061","M5116","M4726","M4316","Z23","M7631","R232","R030","D72818","R6889","H2511","H2512","G629","E559","H35371","H43811","Z98890","H2513","R200","H43813","H9190","H35372"],"date":["2025-06-02","2024-12-16","2025-06-18","2024-11-22","2023-09-19","2023-09-26","2023-09-26","2025-04-08","2025-05-05","2025-05-05","2025-05-05","2024-04-07","2025-02-10","2024-09-10","2025-05-05","2023-10-23","2024-05-15","2024-07-29","2023-09-19","2023-09-19","2025-04-08","2023-09-26","2023-09-26","2025-09-10","2024-04-05","2023-12-18","2024-01-23","2025-07-31","2024-12-12","2024-05-21","2024-05-21","2023-08-29","2024-03-21","2025-01-28","2025-06-02","2025-06-02","2025-06-02","2023-11-01","2024-03-21","2023-11-01","2023-11-01","2025-09-18","2024-08-28","2024-08-28","2024-08-28","2024-08-28","2023-10-11","2024-01-23","2024-01-23","2024-01-23","2022-10-07","2022-10-07","2022-09-22","2022-09-08","2022-08-19","2022-08-19","2022-08-30","2022-08-30","2022-08-30","2022-07-20","2022-03-04","2021-12-10","2021-12-30","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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","DIFLUPREDNATE","","","Select","Select",""],["","","OFLOXACIN","","","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":""}]}]}