{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carol D Rosenberg","gend":1,"currentgend":"","add":"27 GREENWOOD DRIVE","city":"BREWER","state":"ME","zip":"04412","dob":"1951-12-25","age":"","mstatus":"","insh":"10000066389","cliId":"","pno":2076311009,"cno":"","email":"Crosenberg989@gmail.com","ename":"","eno":"","pphy":"RIKER, KERRY S","ppno":2079073300,"pcpadd":"St Joseph Internal Medicine,900 Broadway Bldg 5","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"27 GREENWOOD DRIVE","madd2":"","madd3":"","mcity":"BREWER","mstate":"ME","mzip":"04412","pcpfaxno":2079071923,"pcpnpi":1033199591,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9VX8GM7UC50","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M353","E039","E1165","E7800","Z0000","R6889","M542","M25551","E113399","M5416","Z794","E113293","H43813","E113291","E113312","H43811","H43812","E119","J069","L821","M9905","M7061","Z1231","M79604","M47812","M160","L814","D229","Z0101","H5203","H524","H52203","E113392","M5116","M4727","E113311","M1990","M7581","L80","E113292","M5441","Z7952","M7910","R059"],"date":["2025-05-27","2023-01-03","2024-01-08","2025-08-21","2024-01-08","2023-09-28","2024-01-11","2023-10-19","2025-09-02","2023-08-09","2025-09-02","2025-10-28","2025-10-28","2024-10-29","2024-04-29","2024-10-29","2024-10-29","2025-08-21","2025-01-03","2025-02-25","2023-09-25","2023-08-03","2025-03-07","2024-09-06","2024-01-11","2023-08-09","2025-02-25","2025-02-25","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2024-10-29","2022-09-13","2022-09-13","2022-09-13","2022-08-31","2022-08-31","2022-06-29","2022-06-28","2022-06-29","2022-06-01","2022-05-10","2022-05-10"],"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":[["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","INSULIN DEGLUDEC PEN (U-200)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","PENTOXIFYLLINE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","FREESTYLE LITE METER","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","FLOVENT HFA","","","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":""}]}]}