{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pamela L Murray Senay","gend":1,"currentgend":"","add":"86 HEARN RD","city":"SACO","state":"ME","zip":"04072","dob":"1954-06-22","age":"","mstatus":"","insh":"10000067605","cliId":"","pno":2072824834,"cno":"","email":"pamelasenay@gmail.com","ename":"","eno":"","pphy":"BOUCHER CORNELIO, CATHERINE","ppno":2072838800,"pcpadd":"SMHC Family Medicine,13 Industrial Park Rd Ste 2","pcpcity":"Saco","pcpstate":"ME","pcpzip":"04072","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"86 HEARN RD","madd2":"","madd3":"","mcity":"SACO","mstate":"ME","mzip":"04072","pcpfaxno":2072943561,"pcpnpi":1447571864,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2CH0TM7KJ02","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C412","C761","M79671","H524","Z961","H40013","S92351A","Z981","M8950","M5412","D4989","E039","E119","R4182","C7951","R110","G43E09","R9389","Z98890","Z1231","M899","E669","G43909","D480","F411","F418","Z6837","Z1211","M25511","R200","R202","G43709","Z0101","R918","K769","D434","M50223","M4804","M47812","M8589","M542","M898X1","C7952","C801","I10","M4722","K219","M21962","M7710","R509","G43719","M5011","M810","R748","G9589","M7989","M50122","E6601","B370","H109","J4530","G44209","Z0000","Z9181","Z6836","E785","Z6838","B079","R0982","J329","L989","J3489","J0190","M818","R6889","R0789","R0602"],"date":["2024-12-13","2024-12-13","2023-09-21","2025-10-16","2025-10-16","2025-10-16","2023-09-21","2025-02-05","2024-12-13","2025-11-17","2024-12-13","2025-03-07","2024-12-13","2024-12-13","2024-11-01","2023-08-03","2025-10-30","2025-01-08","2024-10-18","2025-06-27","2024-11-13","2024-02-14","2023-10-04","2024-12-03","2024-02-07","2024-02-07","2024-02-07","2024-06-17","2024-05-30","2024-05-30","2024-05-30","2024-10-31","2023-09-26","2024-10-11","2024-10-11","2024-12-13","2024-10-07","2024-10-07","2024-10-03","2025-03-18","2025-05-16","2025-05-16","2024-11-01","2024-11-01","2025-03-21","2025-05-06","2024-06-17","2024-10-29","2025-11-13","2023-02-09","2024-04-15","2025-05-06","2025-04-24","2023-08-03","2024-11-01","2024-10-29","2024-09-16","2025-11-13","2024-09-11","2023-12-05","2023-12-05","2023-12-05","2025-03-07","2025-03-07","2023-11-02","2024-06-17","2022-07-11","2022-08-02","2022-05-19","2022-05-11","2022-07-19","2022-07-19","2022-05-11","2022-07-25","2022-04-21","2022-04-16","2022-04-05"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","ELETRIPTAN HBR","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","NADOLOL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","CEFDINIR","","","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":""}]}]}