{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Audrey A Weiand","gend":1,"currentgend":"","add":"15 RIVERPLACE DR UNIT 1542","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1950-10-12","age":"","mstatus":"","insh":"10000068905","cliId":"","pno":2075360348,"cno":"","email":"declined@08262024.com","ename":"","eno":"","pphy":"SILCO, MICHAELA O","ppno":2072838800,"pcpadd":"100 GANNETT DRIVE,SUITE C","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 RIVERPLACE DR UNIT 1542","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2072869853,"pcpnpi":1114212149,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6P83JE9HM06","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M4802","R2681","C4491","M47812","R519","G5601","Z23","Z0001","M810","R634","M5450","J4540","M542","M40209","Z1231","Z1211","J479","Z98890","R202","J984","M47813","M792","Z0000","G478","M47816","G5602","Z0100","C44310","D0472","L820","C44712","C44519","H35363","G10","M546","L570","D492","M50122","R918","G5603","G243","M5136","M4316","L578","D225","G5620","L309","D0461","L821","C44319","J45909","I4891","G8929","J181","F418","D509","L814","M25551","N1831","M549","Z13220","D122","Z860101","D123","M48061","M5127","M47817","G252","S81801A","Y939","Y929","I77810","C801","Z131","F330","F411","F5104","L905","M419","M5416","M7918","M50323","M4312","D508","F32A","N289","R002","J111","R6889","R059","R69","J4520","Z03818","S82001A","M25561","M6281","J9811","M7138","M532X6","K921","N6323","R928","N6489","M25461","W19XXXA","S82124A","S82034A","S82124D","S82034D"],"date":["2025-01-07","2025-01-07","2025-11-10","2025-07-02","2025-07-02","2023-12-06","2025-09-19","2025-03-12","2025-03-12","2025-03-12","2025-02-26","2025-10-21","2025-03-17","2023-06-23","2024-07-05","2025-08-19","2025-10-21","2023-06-07","2023-07-10","2024-07-10","2023-06-13","2025-07-16","2024-01-04","2024-07-31","2025-03-05","2023-10-04","2024-10-08","2025-06-25","2023-04-04","2023-02-21","2025-04-14","2025-04-14","2024-10-08","2025-11-07","2024-02-01","2025-10-14","2025-10-14","2023-06-23","2025-10-21","2023-10-04","2025-11-06","2024-02-01","2024-07-02","2025-04-14","2025-04-14","2023-06-23","2024-10-17","2024-10-17","2025-04-14","2025-04-14","2025-05-21","2023-10-04","2025-03-17","2023-05-03","2025-05-21","2025-05-21","2025-04-14","2024-02-01","2025-01-14","2024-07-02","2024-01-03","2025-08-19","2025-08-19","2025-08-19","2024-07-02","2024-07-02","2024-07-02","2023-10-04","2023-04-18","2023-04-18","2023-04-18","2025-01-14","2024-11-05","2025-01-14","2023-05-17","2023-05-17","2023-05-17","2023-04-04","2023-08-25","2023-03-15","2023-03-15","2023-05-17","2023-05-17","2025-01-14","2023-03-12","2022-11-08","2022-11-08","2022-07-26","2022-07-26","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-04-25","2022-04-25","2022-04-25","2022-04-01","2021-11-30","2021-11-19","2022-01-27","2022-01-04","2022-01-04","2022-01-04","2021-12-30","2021-12-30","2022-01-06","2022-01-06","2022-02-09","2022-02-09"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AUSTEDO XR TITRATION KT(WK1-4)","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","FLUTICASONE-VILANTEROL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","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":""}]}]}