{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charlene A Stone","gend":1,"currentgend":"","add":"20 AMES POINT RD","city":"NORTH HAVEN","state":"ME","zip":"04853","dob":"1936-11-02","age":"","mstatus":"","insh":"10000063782","cliId":"","pno":2078674600,"cno":"","email":"doug.stone37@gmail.com","ename":"","eno":"","pphy":"REISER, LORRAINE M","ppno":2078672021,"pcpadd":"North Haven Medical Clinic\t,135 Main St","pcpcity":"North Haven","pcpstate":"ME","pcpzip":"04853","pcpcounty":"","pcpid":"","pcpname":"NORTH HAVEN MEDICAL CLINIC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 AMES POINT RD","madd2":"","madd3":"","mcity":"NORTH HAVEN","mstate":"ME","mzip":"04853","pcpfaxno":2078672258,"pcpnpi":1326155862,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2JY0EN9JR31","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N3091","R531","H353211","I639","M150","I10","R5383","F411","F5104","E860","N289","N10","R296","H547","D649","E538","E875","R630","R0789","M549","Z23","K5900","R944","E785","R7989","I6381","G319","L03119","F329","G8929","R519","M25559","M25562","M25572","M4854XD","M4856XD","G4709","K117","F418","Z0001","U071","R5381","J449","S0512XA","A6920","M50121","M4722","M4312","M1712","M11262","M5137","M47816","M4316","R110","L0390","R5382","K2950","S81802A","M5450","M5412","Z20822","Z0000","R000","M25551","M25552","Z7189","R1013","K222","K269","K3189","Z01818","L570","H353222","R079","L821","D1801","D235","Z85828","D485","M5442","M8000XA","N3001","S3991XA","S3993XA","M4807","M5126","M47817","B351","M5136","H353231","Z9181","S0083XA"],"date":["2023-12-06","2024-01-11","2025-06-17","2025-06-18","2025-06-18","2025-08-25","2025-05-20","2024-06-04","2024-06-04","2025-07-03","2025-07-03","2024-01-09","2025-04-03","2025-03-17","2024-05-21","2025-05-20","2025-04-18","2025-07-22","2024-07-16","2023-12-06","2024-10-25","2024-01-08","2024-01-22","2024-01-22","2024-01-22","2025-06-17","2025-06-17","2024-04-25","2024-07-16","2024-04-25","2025-07-09","2024-07-20","2024-07-20","2024-07-20","2023-12-04","2023-12-04","2024-03-01","2024-03-01","2024-12-06","2024-03-01","2022-10-17","2025-05-20","2024-01-11","2025-08-12","2025-06-03","2023-07-05","2023-07-05","2023-07-05","2023-07-05","2023-07-05","2023-07-05","2023-07-05","2023-07-05","2025-07-03","2024-12-13","2024-03-01","2025-07-07","2024-09-30","2023-12-08","2023-07-03","2022-10-15","2024-10-22","2024-01-25","2023-11-30","2023-11-30","2025-06-26","2025-07-04","2025-07-09","2025-07-07","2025-07-07","2025-07-10","2024-10-02","2024-06-24","2025-07-10","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2023-12-07","2023-12-07","2023-12-07","2023-11-30","2023-11-30","2023-12-07","2023-12-07","2023-12-07","2024-07-16","2024-07-16","2022-09-13","2022-07-26","2022-07-26"],"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":[["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","MEGESTROL ACETATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","PNEUMOVAX 23","","","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":""}]}]}