{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra C Gilbert Lord","gend":1,"currentgend":"","add":"194 WEST RD","city":"CHESTERVILLE","state":"ME","zip":"04938","dob":"1954-05-09","age":"","mstatus":"","insh":"10000069037","cliId":"","pno":2078979388,"cno":"","email":"scglord@gmail.com","ename":"","eno":"","pphy":"PATTERSON, KRISTIN","ppno":2076218800,"pcpadd":"43 WHITING HILL RD STE 300,","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121006","pcpcounty":"","pcpid":"","pcpname":"AUGUSTA FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"194 WEST RD","madd2":"","madd3":"","mcity":"CHESTERVILLE","mstate":"ME","mzip":"04938","pcpfaxno":2076218801,"pcpnpi":1598323560,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5HE4PF2FT96","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S4352XA","K644","M8589","Z780","F331","E039","K648","E781","Z1231","Z1211","Z1212","Z86010","K635","R21","M7542","M19012","M75112","M75100","M75102","S43432A","M7552","Z0101","S62616D","W19XXXD","Z0000","R92323","S4992XA","W010XXA","Z79899","E785","L239","M810","Z13820","K649","F339","E559","S4992XD","R0602","S46012A","S62616A","Z98890","M8580","Z79890","K642","T7840XA","D123","D120","I10","W19XXXA","W1809XA","K5730","T1512XA","S0502XD","S0502XA","T1512XD"],"date":["2024-11-15","2023-08-04","2023-09-11","2023-09-11","2025-11-10","2025-08-08","2023-08-04","2025-06-05","2024-10-30","2023-10-12","2023-10-12","2023-10-12","2023-11-07","2023-09-18","2024-11-15","2024-11-15","2024-11-15","2024-12-06","2024-11-15","2024-11-15","2024-11-15","2025-02-12","2023-03-07","2023-03-07","2025-06-02","2025-10-02","2024-08-12","2024-05-30","2024-10-01","2024-11-06","2023-09-14","2025-11-11","2025-11-11","2023-04-18","2023-03-20","2023-11-07","2024-07-02","2023-08-31","2024-08-12","2023-02-26","2024-12-03","2025-06-28","2023-11-09","2023-02-03","2023-08-31","2023-10-12","2023-10-12","2023-09-14","2024-04-16","2024-04-19","2023-10-12","2022-08-08","2022-08-08","2022-08-09","2022-08-09"],"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":[["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","LEQVIO","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","RALOXIFENE HCL","","","Select","Select",""],["","","EUTHYROX","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","SIMVASTATIN","","","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":""}]}]}