{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Helen S Tracey","gend":1,"currentgend":"","add":"193 NEW GORHAM RD","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1952-11-23","age":"","mstatus":"","insh":"10000069195","cliId":"","pno":2076100482,"cno":"","email":"hzsltop@gmail.com","ename":"","eno":"","pphy":"KING, KARYN R","ppno":2078741489,"pcpadd":"InterMed,100 Foden Rd Ste 203","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"193 NEW GORHAM RD","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":2075238590,"pcpnpi":1952890485,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8TP1F53FK28","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1712","G8929","M25562","H35342","H43811","L409","M25569","L4050","R030","F17200","M170","Z79620","Z7961","Z98890","K5720","Z48815","L400","Z23","L03114","Z0100","M25561","S61227A","W260XXA","R21","R195","H2511","M059","L0291","T50905A","H2512","J449","K5900","K5710","N281","Z933","Z0101","H01003","H01006","Z79899","M8580","N390","R110","F17210","Z9049","S61227D","W260XXD","L03113","K6389","Z433","Z0000","K529","R140","R0602","R197","G8918","K435","N764","R011","M810"],"date":["2025-07-23","2025-07-23","2025-07-23","2025-06-18","2025-06-18","2025-10-06","2025-03-20","2025-11-03","2023-12-13","2025-03-20","2025-03-20","2025-10-31","2025-10-06","2025-07-15","2024-02-10","2024-07-25","2025-08-22","2024-09-12","2023-06-29","2023-06-29","2025-03-20","2024-03-29","2024-03-29","2023-12-14","2022-12-30","2023-08-30","2025-10-06","2025-09-24","2025-09-24","2023-08-23","2024-06-11","2025-05-07","2025-05-07","2025-05-07","2024-06-11","2025-04-15","2025-04-15","2025-04-15","2025-01-24","2023-10-12","2025-05-07","2025-05-07","2025-05-07","2024-06-06","2024-04-11","2024-04-11","2023-07-13","2024-06-17","2024-06-19","2025-04-04","2023-04-24","2024-06-15","2024-06-15","2023-04-24","2024-06-11","2024-06-11","2025-09-22","2024-01-30","2022-10-05"],"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":[["","","COSENTYX","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","REMICADE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","XDEMVY","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","SIMBRINZA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NEOMYCIN SULFATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","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":""}]}]}