{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carol A Gray","gend":1,"currentgend":"","add":"484 RIVER RD","city":"Topsham","state":"ME","zip":"04086","dob":"1950-05-29","age":"","mstatus":"","insh":"10000062651","cliId":"","pno":2077293081,"cno":"","email":"declined@12042023.com","ename":"","eno":"","pphy":"PARRIS, KRISTIN H","ppno":2074067600,"pcpadd":"301C US ROUTE 1,","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40749701","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"484 RIVER RD","madd2":"","madd3":"","mcity":"Topsham","mstate":"ME","mzip":"04086","pcpfaxno":2073968632,"pcpnpi":1386632289,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5G98PH8CF32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5111","I110","I5021","I214","D649","R1013","I5022","I493","I340","I4729","R931","N132","R55","K319","C672","Z451","Z8551","D500","A000","L570","R001","I428","I130","I5020","D509","T8383XA","I252","N2889","C679","I2510","I513","N1330","N12","R319","R42","R079","I10","E782","R0602","E785","E669","E039","R935","E278","H40013","Z0101","E119","R310","R531","Z87898","L989","D3502","F32A","R238","L0100","J3489","E6601","Z6835","I77810","I700","Q248","I509","N200","R1084","M5489","I501","I5189","Z960","L821","L578","L814","Z0000","K922","D892","R911","K3189","D128","R109","T83592A","R5383","R0789","Z923","I253","I358","R1031","C673","I21A1","C676","M25551","Z0389","R10816","N131","Z08","K2270","M160","M25552","J939","K5730","D3501","Z87891","R4020","N179","R1011","E1100","Z1231","K760","R69","M5450","G8929","I498","R9089","I6529","R413","N136","K5900","I4891","K219","I471","I4720","I50810","I422","I081","J301","N201","I7091","M546","F418","J45909","D492","D090","Z85828","Z510","I517","J9811","Z8616","C678"],"date":["2024-07-25","2023-09-07","2023-08-21","2023-04-12","2023-04-12","2023-09-14","2025-09-15","2023-11-21","2023-06-02","2023-06-02","2023-10-17","2023-09-07","2023-11-21","2023-09-13","2025-11-14","2025-07-22","2025-11-10","2025-11-14","2023-09-16","2025-10-02","2023-06-01","2023-06-02","2023-09-17","2023-08-24","2024-07-15","2023-09-17","2023-06-22","2024-03-08","2025-07-07","2024-05-10","2023-10-30","2023-09-21","2023-09-21","2023-09-21","2023-09-14","2023-09-12","2023-11-10","2023-08-03","2023-09-08","2024-06-13","2024-06-13","2024-06-13","2024-05-10","2025-11-10","2023-12-08","2023-12-08","2024-04-30","2023-10-30","2023-10-30","2024-06-27","2023-01-16","2023-10-02","2023-10-02","2022-12-30","2022-12-30","2025-09-15","2025-09-15","2025-09-15","2023-11-10","2023-11-10","2023-11-10","2023-10-17","2023-09-07","2023-09-17","2023-09-06","2023-06-02","2023-11-10","2023-09-15","2025-10-02","2025-10-02","2025-09-18","2024-01-29","2023-09-05","2024-02-26","2025-07-07","2023-04-12","2023-04-12","2024-03-18","2023-10-16","2023-09-12","2023-09-12","2024-11-01","2023-08-21","2023-08-21","2023-09-17","2024-06-19","2023-04-10","2025-06-25","2025-04-30","2023-04-09","2023-08-25","2023-09-07","2024-11-01","2023-09-13","2025-04-30","2025-04-30","2025-11-10","2023-09-12","2023-08-25","2023-05-10","2023-06-02","2023-08-20","2023-08-20","2023-04-20","2023-05-08","2023-09-12","2023-06-14","2023-07-10","2023-08-15","2023-05-17","2023-09-12","2023-09-12","2023-09-12","2023-09-17","2024-07-08","2023-05-08","2024-05-28","2023-05-17","2023-05-17","2023-04-08","2023-04-08","2023-04-08","2025-04-29","2023-09-06","2023-09-06","2023-08-15","2024-05-28","2024-05-28","2025-10-02","2024-04-02","2025-10-02","2024-07-09","2023-09-06","2023-09-06","2022-07-13","2022-06-26"],"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":[["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","LIDOCAINE-PRILOCAINE","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","QUVIVIQ","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ESTRADIOL","","","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":""}]}]}