{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michele E Devou","gend":1,"currentgend":"","add":"145 MCKENNEY RD","city":"Saco","state":"ME","zip":"04072","dob":"1953-06-07","age":"","mstatus":"","insh":"10000068675","cliId":"","pno":"","cno":2078072997,"email":"Michelle.devou@gmail.com","ename":"","eno":"","pphy":"BUCHBERGER, GLENN K","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 700","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"145 MCKENNEY RD","madd2":"","madd3":"","mcity":"Saco","mstate":"ME","mzip":"04072","pcpfaxno":2075238597,"pcpnpi":1598054702,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4R12QY6KP91","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M4802","S8992XA","M50320","M47812","M4312","I10","N200","K5792","R1011","R198","M48062","M25561","M549","R2689","E83110","K2980","K591","R351","A000","Z0000","Z23","R109","G959","K219","E039","H401131","R202","R399","G629","M25552","M67959","M5136","Z981","E83119","L4059","M1712","M792","M25562","W1789XA","J449","C965","L408","L680","L578","D225","G5712","S0083XA","E119","H52223","Z4789","Z1231","M2012","M2011","L600","K529","B070","M5450","M6281","L404","B009","R2241","N2889","K5730","I739","R21","R600","R609","H2511","E785","K635","R7982","R194","J3489","M79604","R531","K5790","S3992XA","S6992XA","S6991XA","I129","H9202","R29818","I517","R292","H40013","H02886","Z01812","R053","Z86010","R197","M5137","M47816","M50322","M25461","N181","H04123","R55","M25559","S3991XA","S3993XA","R208","S0990XA","R252","R000","R0602","S199XXA","R4182","R001","R002","H903","Z98890","H938X1","R220","M1612","M4800","H6983","J3081","R931","R058","L4050","Z79899","K644","M79606","R209","T1512XA","K5900","U071","K5909","M5127","M47817","G992","H608X3","Z96651","M50022","M50023","E7800","M438X2","R739","J984","K589","J432","S299XXA","J8489","S0990XD","S60219D","R0902","G4736","N3289","B081","Z0001","E559","E8352","N281","R1032","R110","C966","N1330","Z87891","H2512","N182","I87323","J349","M25519","D485","H2513","H11122","G514","H259","H02056","H40003","Z0101","R7309","R1013","R935","K449","K3189","M79605","S86912A","E1122"],"date":["2024-11-21","2023-10-06","2024-02-05","2024-02-05","2024-11-08","2025-04-23","2023-01-19","2024-11-05","2023-10-26","2023-07-20","2025-11-12","2023-02-22","2024-03-12","2024-03-12","2024-11-05","2022-12-09","2022-12-09","2025-11-03","2024-02-18","2024-10-07","2025-02-03","2023-07-17","2025-10-20","2024-02-13","2025-10-18","2025-10-14","2025-10-18","2023-07-17","2025-04-14","2023-11-13","2023-11-13","2023-11-13","2024-06-10","2025-08-08","2025-05-06","2023-10-24","2025-08-26","2023-10-06","2023-10-06","2025-10-26","2025-06-02","2023-11-02","2023-11-02","2023-11-02","2023-11-02","2023-07-18","2023-10-06","2023-10-06","2023-02-07","2024-03-19","2024-04-12","2023-02-14","2023-02-14","2023-02-14","2023-08-14","2023-03-07","2025-04-16","2025-04-16","2023-10-12","2023-10-12","2024-04-15","2023-07-17","2023-12-20","2025-08-22","2023-10-02","2024-04-15","2024-05-08","2022-12-29","2022-12-29","2023-12-20","2024-02-06","2024-11-05","2025-04-08","2023-12-20","2024-01-18","2023-01-07","2022-12-18","2022-12-18","2022-12-18","2022-12-18","2024-12-13","2024-12-13","2025-04-22","2024-01-18","2024-02-12","2023-08-07","2023-12-26","2025-01-22","2023-12-20","2023-12-20","2024-01-18","2025-08-26","2024-01-18","2023-02-22","2023-10-26","2023-09-08","2025-03-21","2023-03-16","2023-01-07","2023-01-07","2024-07-02","2023-10-06","2023-12-26","2023-12-20","2025-06-27","2023-10-06","2024-08-07","2024-08-07","2025-10-29","2025-04-08","2024-11-08","2023-09-28","2025-04-14","2023-10-16","2025-10-20","2023-03-28","2023-03-28","2025-04-22","2024-09-26","2023-10-24","2023-07-25","2025-07-24","2025-07-24","2025-07-24","2023-09-08","2024-03-12","2024-09-26","2024-03-14","2025-10-18","2025-10-18","2024-02-13","2025-09-19","2023-02-22","2024-02-13","2024-02-13","2024-09-30","2024-02-13","2024-09-30","2025-04-07","2023-04-21","2025-06-02","2023-01-07","2023-09-25","2022-12-22","2022-12-22","2022-11-22","2022-11-22","2022-11-21","2022-10-26","2022-09-26","2022-09-22","2022-09-22","2022-08-30","2022-08-25","2022-08-25","2022-08-18","2022-08-25","2022-09-02","2022-07-20","2022-08-02","2022-07-07","2022-06-28","2022-06-15","2022-06-13","2022-06-06","2022-06-06","2022-06-06","2022-03-08","2022-03-08","2021-12-10","2021-12-10","2021-12-10","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2022-02-22","2022-02-22","2022-02-22"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","CAPVAXIVE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","ADACEL TDAP","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TALTZ AUTOINJECTOR (2 PACK)","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","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":""}]}]}