{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah J Guptill","gend":1,"currentgend":"","add":"45 SIMPSON WHARF RD","city":"EAST MACHIAS","state":"ME","zip":"04630","dob":"1954-02-05","age":"","mstatus":"","insh":"10000066641","cliId":"","pno":2072558464,"cno":"","email":"lguptill@roadrunner.com","ename":"","eno":"","pphy":"MOULTON, CHRISTINE C","ppno":2072550102,"pcpadd":"Regional Medical Center at Lubec,893 Main St","pcpcity":"East Machias","pcpstate":"ME","pcpzip":"04630","pcpcounty":"","pcpid":"","pcpname":"REGIONAL MEDICAL CENTER AT LUBEC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 269","madd2":"","madd3":"","mcity":"EAST MACHIAS","mstate":"ME","mzip":"04630","pcpfaxno":2077332127,"pcpnpi":1588643886,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7Q50FP7YW11","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E669","Z1231","E6601","Z124","B351","L84","M2141","M7741","G629","M2041","M2042","L603","L853","M79671","D122","D124","Z0101","H524","H2513","N952","N816","L680","Z01411","G5763","Z1211","K6389","L989","I10","Z136","Z1151","Z01419","H5212","H5201","R6889","M21611","M21612"],"date":["2025-08-11","2025-05-12","2023-05-08","2023-02-03","2024-01-19","2024-04-19","2025-04-04","2024-12-06","2023-03-15","2024-02-23","2024-02-23","2024-04-19","2024-04-19","2023-08-08","2023-10-27","2023-10-27","2025-04-25","2025-04-25","2024-03-29","2025-02-25","2025-02-25","2024-02-06","2025-02-25","2024-09-13","2023-10-27","2023-10-27","2024-12-09","2024-05-13","2024-05-13","2023-02-03","2023-02-03","2025-04-25","2025-04-25","2023-09-01","2023-09-22","2022-08-12"],"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":[["","","ACYCLOVIR","","","Select","Select",""],["","","JUBLIA","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","TERBINAFINE 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":""}]}]}