{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane E Curtis","gend":1,"currentgend":"","add":"58 ESTATES DR UNIT 2","city":"MANCHESTER","state":"ME","zip":"04351","dob":"1954-06-06","age":"","mstatus":"","insh":"10000068551","cliId":"","pno":2074465109,"cno":"","email":"Mecurtis1952@gmail.com","ename":"","eno":"","pphy":"BROWN, JASON","ppno":2076218800,"pcpadd":"Augusta Family Medicine,15 Enterprise Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"AUGUSTA FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 249","madd2":"","madd3":"","mcity":"MANCHESTER","mstate":"ME","mzip":"04351","pcpfaxno":2076218801,"pcpnpi":1740592658,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6RM1EE1QW25","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M810","Z780","M20032","M5441","M25551","Z0001","L989","M8580","M7918","Z1231","R92323","S8002XD","R1031","G8929","M79674","Z0000","J309","E039","H6123","M1611","J069","H6991","M549","M5126","X501XXA","S8002XA","S20212A","M25562","Z0101","M9905","M461","M9904","M5431","S99921S","M5450","K5900","M47816","R0781","M7989","H109","Z13820","S99922A","W500XXA","Y92009","G4700","S93529A","M79645","S99922D","H2513","S93521A","M51360","R6889","R937","S99921D","S2020XA","S99821D","Z23","R059","Z8616","D3132"],"date":["2022-12-23","2025-04-22","2025-04-16","2025-09-22","2025-10-22","2024-07-09","2024-07-09","2025-04-22","2025-08-07","2025-10-30","2025-10-30","2023-02-21","2025-08-05","2024-04-15","2024-04-15","2025-07-16","2025-07-16","2025-07-16","2024-10-30","2025-10-22","2024-10-30","2024-10-30","2025-09-21","2025-09-21","2025-09-21","2023-01-26","2023-01-16","2023-11-27","2025-08-05","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2023-08-21","2025-08-05","2025-09-22","2025-09-21","2023-01-16","2023-01-16","2025-07-02","2025-04-21","2024-08-23","2024-08-23","2024-08-23","2024-11-07","2023-09-08","2024-12-09","2024-08-23","2023-10-31","2023-09-08","2025-09-21","2023-01-04","2023-04-20","2023-10-09","2023-01-16","2023-10-09","2022-11-10","2022-10-18","2022-10-18","2022-09-22"],"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":[["","","FLUAD 2025-2026","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AZITHROMYCIN","","","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":""}]}]}