{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda P Weeks","gend":1,"currentgend":"","add":"22 SAVAGE ST","city":"FAIRFIELD","state":"ME","zip":"04937","dob":"1954-04-26","age":"","mstatus":"","insh":"10000070259","cliId":"","pno":2074536562,"cno":"","email":"CABER54@HOTMAIL.COM","ename":"","eno":"","pphy":"LEBLANC, CHRISTINA","ppno":2078731098,"pcpadd":"MaineGeneral Medical Center,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"THAYER INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"22 SAVAGE ST","madd2":"","madd3":"","mcity":"FAIRFIELD","mstate":"ME","mzip":"04937","pcpfaxno":2078615461,"pcpnpi":1154773935,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7DW6R47NC47","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F418","F331","F5081","K219","R2689","F419","N393","F50811","M25561","M6281","M62831","M1712","Z471","M24569","R531","M24562","H2511","G4733","R21","Z96651","M24561","M9901","M531","M542","M9904","G8918","I10","H35363","R768","M25562","R350","R32","M5450","Z1231","H527","H2512","M170","Z79899","Z1211","D123","I517","R9431","D649","R7303","Z96653","M25462","Z96652","Z0000","M25461","R200","M1711","N3941","G4730","Z9989","M25872","M19072","M7989","M659","M7732","K5520","K5730","F32A","H18513","R6889","M8580","Z780","Z6837","H35373","Z01818","R42","R5383","E669","Z01419","E559","G8929","R262","M79672","H2513","H04123"],"date":["2025-11-06","2025-11-06","2024-09-19","2024-10-29","2024-10-29","2024-10-29","2024-10-29","2025-11-06","2024-09-10","2024-09-10","2024-09-10","2023-06-29","2024-05-22","2023-09-13","2023-06-22","2023-06-22","2024-11-26","2025-09-04","2022-11-29","2023-12-20","2023-12-20","2023-12-07","2023-12-07","2023-12-07","2023-12-07","2023-09-26","2025-09-08","2025-06-30","2022-11-29","2022-11-29","2024-03-04","2024-03-04","2024-03-04","2025-02-20","2024-12-30","2024-11-19","2023-06-01","2025-11-06","2024-12-13","2024-12-13","2023-10-26","2023-10-26","2025-09-09","2025-09-08","2024-05-22","2023-07-12","2023-07-12","2023-12-04","2023-10-11","2025-10-08","2023-09-26","2024-09-27","2025-01-16","2025-01-16","2023-01-09","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2024-12-13","2024-12-13","2025-11-05","2024-10-02","2023-12-08","2025-02-20","2025-02-20","2023-06-27","2025-06-30","2023-06-01","2024-07-31","2025-02-20","2023-06-27","2022-11-08","2022-11-10","2022-11-25","2022-10-25","2022-10-31","2022-10-11","2022-10-11"],"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":[["","","PREVNAR 20","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","ADACEL TDAP","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","LISDEXAMFETAMINE DIMESYLATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ADDERALL XR","","","Select","Select",""],["","","VYVANSE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUCONAZOLE","","","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":""}]}]}