{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anne B Lawler","gend":1,"currentgend":"","add":"105 PRIDE RD","city":"AUBURN","state":"ME","zip":"04210","dob":"1954-10-12","age":"","mstatus":"","insh":"10000070693","cliId":"","pno":2072404339,"cno":2072404339,"email":"ALAWLER850@AOL.COM","ename":"","eno":"","pphy":"CLOUTIER, LISE M","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"105 PRIDE RD","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":2077955727,"pcpnpi":1386624096,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1N56XH4TX42","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R053","M4802","M5011","M4722","M4312","I491","M1711","M5412","F10129","Z1211","K635","K5730","K648","Z98890","G5712","M50322","M47812","H259","Z8673","K056","R079","T1490XA","M25561","I10","S0003XA","R0781","G9389","M25569","M5416","J069","S0230XA","S20229A","W01190A","Y939","Y92009","G40409","M7918","F10920","Z1231","Z0101","H2513","H43812","R002","R9431","S0181XA","Z0000","R0602","R059","F331","D649","M5410","R12","R5383","H2511","H2512","Z4802","S0990XA","F10929","E559","E7800","F329","R7989","I351","M5021","J40","R6889","M79602","V892XXA","Z780","M85852","Z9841","Z9842","M47817","M4317","M48061"],"date":["2025-03-02","2025-09-05","2024-10-30","2024-10-30","2024-10-30","2025-03-03","2025-11-13","2024-12-05","2025-07-07","2025-05-07","2025-05-07","2025-05-07","2025-05-07","2024-10-30","2024-06-10","2024-06-10","2025-09-17","2023-10-04","2025-09-05","2025-09-05","2025-07-08","2025-07-08","2025-10-13","2025-03-18","2025-07-08","2023-05-29","2025-09-17","2025-11-07","2024-05-22","2025-02-24","2023-02-07","2023-05-29","2023-05-29","2023-05-29","2023-05-29","2023-02-07","2024-08-14","2025-07-07","2025-04-02","2025-01-29","2023-07-05","2023-02-24","2023-06-13","2023-06-13","2024-05-13","2024-12-18","2025-03-02","2025-03-02","2023-06-20","2025-06-17","2025-06-17","2025-06-17","2025-06-17","2023-10-04","2023-09-20","2024-05-21","2025-09-17","2025-07-07","2022-12-02","2023-04-11","2023-04-11","2023-04-11","2023-07-06","2025-09-17","2025-02-08","2023-03-27","2024-05-08","2024-05-08","2023-03-28","2023-03-28","2025-01-29","2025-01-29","2022-10-03","2022-10-03","2022-10-03"],"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":[["","","DULOXETINE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","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":""}]}]}