{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean E Lyden","gend":1,"currentgend":"","add":"1500 FOREST AVE APT 5D","city":"PORTLAND","state":"ME","zip":"04103","dob":"1952-10-12","age":"","mstatus":"","insh":"10000065838","cliId":"","pno":2078781963,"cno":2073470491,"email":"","ename":"","eno":"","pphy":"ASBJORNSEN, CYNTHIA B","ppno":2072217799,"pcpadd":"100 FODEN RD,SUITE 307 WEST","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062327","pcpcounty":"","pcpid":"","pcpname":"VEIN HEALTHCARE CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1500 FOREST AVE APT 5D","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2072213544,"pcpnpi":1427248681,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4PG5CJ4XF98","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D072","M319","I83893","I83813","R87621","L309","L308","H2513","H43811","H524","H5213","D485","L905","L942","R112","I83892","N393","M85859","J069","R059","E2609","I10","L720","D492","L821","D1801","L814","M85852","Z1272","R87612","R87623","S61210A","K219","I499","R4182","Z23","Z780","B977","D225","L608","I8310","M67431","R7309","H18413","B009","Z0000","N951","R1110","D071","N871","Z90710","N842","Z85828","A630","L280"],"date":["2025-05-07","2024-07-18","2025-05-05","2024-11-14","2023-11-08","2024-08-01","2024-08-16","2025-09-23","2025-09-23","2025-09-23","2025-09-23","2024-07-12","2024-07-12","2024-07-12","2025-02-28","2024-12-05","2025-11-03","2025-11-03","2022-12-15","2022-12-15","2022-12-15","2024-11-15","2024-04-16","2024-07-12","2025-07-01","2025-07-01","2025-07-01","2025-10-27","2025-05-07","2025-05-07","2024-05-17","2023-04-08","2024-11-15","2024-11-15","2024-11-15","2023-04-08","2025-10-27","2023-11-08","2025-07-01","2023-07-13","2024-10-21","2025-07-23","2024-09-18","2024-09-18","2022-12-29","2025-04-18","2025-04-18","2025-04-18","2024-05-17","2024-05-17","2022-11-02","2022-05-18","2022-07-07","2022-05-18","2022-01-19"],"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":[["","","FLUAD 2025-2026","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","PREMARIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","FLUAD 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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}