{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Denise M Bessette","gend":1,"currentgend":"","add":"4 PEARSON PL","city":"KITTERY","state":"ME","zip":"03904","dob":"1954-03-15","age":"","mstatus":"","insh":"10000066907","cliId":"","pno":2077036674,"cno":"","email":"denise.bessette523@gmail.com","ename":"","eno":"","pphy":"COPPINS, NICHOLAS J","ppno":2074394430,"pcpadd":"Kittery Family Practice,35 Walker St Ste 100","pcpcity":"Kittery","pcpstate":"ME","pcpzip":"03904","pcpcounty":"","pcpid":"","pcpname":"KITTERY FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4 PEARSON PL","madd2":"","madd3":"","mcity":"KITTERY","mstate":"ME","mzip":"03904","pcpfaxno":2074390968,"pcpnpi":1568937159,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4TK7FE5NM65","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9901","M9905","M25511","M25561","M9902","M546","G43109","M542","M47812","M7672","M85852","M8588","Z8742","Z01419","Z1211","R29818","R6889","M84472A","M25462","Z1231","H43811","M5450","L292","Z0000","M24872","M1990","Z0101","R9230","Z86010","M25461","Z83719","M25579","R600","S83231D","R922","M25572","S92142A","Z780","A6004","N760","Z113"],"date":["2025-06-13","2024-01-30","2023-08-09","2024-07-17","2025-06-13","2025-06-13","2023-04-03","2025-06-13","2023-03-03","2025-11-06","2023-08-03","2023-08-03","2024-07-03","2025-08-25","2024-09-04","2023-03-13","2023-10-02","2025-08-26","2025-08-26","2024-08-05","2023-08-09","2022-12-21","2024-04-16","2025-08-14","2025-11-18","2023-05-16","2025-03-06","2024-09-24","2024-09-04","2024-10-02","2024-09-04","2025-07-21","2025-06-16","2024-10-16","2023-09-18","2025-06-16","2025-08-26","2023-08-03","2022-06-16","2022-06-16","2022-06-16"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","ESTRADIOL (ONCE WEEKLY)","","","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":""}]}]}