{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Denise L Huntington","gend":1,"currentgend":"","add":"174 SMITHVILLE RD","city":"STEUBEN","state":"ME","zip":"04680","dob":"1954-12-29","age":"","mstatus":"","insh":"10000066156","cliId":"","pno":2075467621,"cno":2078419814,"email":"denisehuntington101@yahoo.com","ename":"","eno":"","pphy":"RAMSAY, DREW C","ppno":2075462391,"pcpadd":"Milbridge Medical Center,24 School St","pcpcity":"Milbridge","pcpstate":"ME","pcpzip":"04658","pcpcounty":"","pcpid":"","pcpname":"MILBRIDGE MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"174 SMITHVILLE RD","madd2":"","madd3":"","mcity":"STEUBEN","mstate":"ME","mzip":"04680","pcpfaxno":"","pcpnpi":1720516248,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4JR0NC5UX49","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G2582","R42","J849","F322","F418","F4312","G8929","E2740","Z7901","Z0283","D649","D582","Z0000","K5090","R300","M7918","R519","R21","W57XXXA","G4700","Z79899","G43909","R040","K5080","H5319","H2512","N3000","J8410","I2699","R918","Z0001","E2749","H04123","D6869","G43709","Z515","I82409","K50919","Z86711","D485","D225","L814","L821","Z7189","E538","L820","B078","H2513","E8342","R0600","H10503","F349","G20","G119","Z7952","Z7964","E249","M810","M9908","Z881","Z882","Z884","M8580","E892","F410","K589","F4323","R590","Z01818","J479","J8489","N390","R600","I83893","I872","M7989","D1801","R260"],"date":["2025-05-08","2024-12-03","2024-11-05","2023-09-19","2023-06-08","2023-09-19","2024-11-08","2025-01-03","2024-05-17","2024-06-13","2025-08-26","2025-08-21","2025-02-19","2024-12-31","2025-05-13","2025-07-03","2023-06-28","2023-05-11","2023-05-11","2024-09-19","2025-03-20","2023-02-27","2023-02-27","2024-12-18","2024-10-15","2024-10-15","2023-10-26","2024-05-17","2024-05-17","2024-12-26","2023-02-08","2025-01-28","2024-10-07","2024-09-09","2024-09-09","2025-03-10","2025-08-20","2023-06-28","2022-12-29","2025-01-30","2025-01-30","2025-01-30","2025-01-30","2025-01-30","2024-06-18","2025-01-30","2025-01-30","2024-10-07","2025-09-02","2024-12-26","2023-11-21","2022-12-06","2022-12-06","2024-01-26","2024-09-05","2023-01-18","2024-09-05","2024-06-07","2024-11-05","2023-07-26","2023-07-26","2023-07-26","2025-01-28","2025-01-28","2025-01-28","2022-09-21","2022-09-08","2022-08-19","2022-07-19","2022-08-03","2022-07-19","2022-07-15","2022-07-08","2022-07-08","2022-07-08","2022-07-08","2022-06-20","2022-06-22"],"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":[["","","NURTEC ODT","","","Select","Select",""],["","","FENTANYL","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","TOBRADEX","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","HUMIRA(CF) PEN","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","PROMETHAZINE HCL","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","OXYCONTIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","SERTRALINE HCL","","","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":""}]}]}