{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vicki L Sullivan","gend":1,"currentgend":"","add":"97 WARD RD","city":"Windham","state":"ME","zip":"04062","dob":"1957-12-28","age":"","mstatus":"","insh":"10000065759","cliId":"","pno":2073321089,"cno":"","email":"VICKILYNNSULLIVAN1@GMAIL.COM","ename":"","eno":"","pphy":"MICHAELIS, TODD M","ppno":2078741489,"pcpadd":"InterMed,100 Foden Rd Ste 203","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"97 WARD RD","madd2":"","madd3":"","mcity":"Windham","mstate":"ME","mzip":"04062","pcpfaxno":2075238590,"pcpnpi":1649565672,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2UW2AF4QQ18","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D649","R42","R0600","N179","E876","Z85828","Z23","K5720","D62","L7622","I10","K449","F4323","R1115","Z1231","F410","F331","G43A0","R0602","R079","I209","G8918","K56609","F418","F1290","R053","F17201","J302","L2089","R1013","N281","K7689","R61","R112","F17200","R109","I700","H43813","E860","D125","K5730","K648","H02831","R1084","H02834","H53453","Z720","D539","M533","H8113","E871","I160","D638","R918","K56699","K319","R7401","E781","U071","M797","F17210","N289","K5792","Z87891","Z0001","B349","R051","Z13220","Z131","R140","Z4682","R1011","K5732","E785","J80","R0603","Z9049","Z0000","R1110","R197","R609","C441192","R6510","K120","I348","I77810","R739","R7989","R4182","A419","G9340","I959","I712","H02102","H02105","Z1211","D485","Z0101","R932","K429","Z90710","R509"],"date":["2023-05-22","2023-06-26","2025-03-22","2023-05-17","2023-05-17","2023-05-04","2023-12-06","2023-09-20","2023-09-20","2023-09-20","2025-09-03","2023-08-15","2025-11-17","2025-03-22","2023-02-07","2025-09-03","2025-09-03","2025-09-03","2023-05-04","2023-05-05","2023-05-05","2023-09-13","2023-09-13","2023-09-13","2023-08-20","2025-05-21","2025-05-21","2025-05-21","2025-05-21","2024-11-24","2024-11-24","2023-11-13","2023-11-13","2025-03-22","2024-11-24","2025-03-22","2023-06-13","2025-11-05","2024-11-24","2023-08-15","2023-08-15","2023-08-15","2023-04-24","2025-03-22","2023-04-11","2023-04-11","2023-12-20","2023-06-14","2023-06-14","2023-06-14","2023-12-06","2023-03-30","2023-07-12","2023-11-13","2023-08-28","2023-08-15","2025-10-28","2024-05-01","2024-01-04","2023-12-27","2023-12-27","2023-06-21","2023-06-26","2023-06-21","2023-12-15","2023-12-20","2023-12-20","2023-12-15","2023-12-15","2024-11-24","2024-11-24","2024-11-24","2023-03-30","2023-03-30","2023-05-03","2023-05-03","2024-11-24","2025-05-02","2023-03-29","2023-03-29","2023-03-29","2022-10-18","2022-06-16","2022-06-08","2022-06-07","2022-06-07","2022-06-01","2022-06-02","2022-06-01","2022-06-01","2022-06-02","2022-06-02","2022-06-01","2022-04-06","2022-04-06","2022-03-14","2022-03-24","2021-12-09","2022-02-26","2022-02-26","2022-02-26","2022-02-26"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","HALOPERIDOL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","HYDROCORTISONE BUTYRATE","","","Select","Select",""],["","","FLUZONE QUAD 2021-2022","","","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":""}]}]}