{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beverly F Mcbreairty","gend":1,"currentgend":"","add":"51 Second Ave","city":"Fort Kent","state":"ME","zip":"04743","dob":"1947-10-28","age":"","mstatus":"","insh":"10000072029","cliId":"","pno":2078343257,"cno":"","email":"bevmcb@hotmail.com","ename":"","eno":"","pphy":"Charles T Albert","ppno":2078346140,"pcpadd":"Nmmc Medical Practice,194 E Main St","pcpcity":"Fort Kent","pcpstate":"ME","pcpzip":"04743","pcpcounty":"","pcpid":"","pcpname":"Nmmc Medical Practices","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"51 Second Ave","madd2":"","madd3":"","mcity":"Fort Kent","mstate":"ME","mzip":"04743","pcpfaxno":2078344451,"pcpnpi":1780666990,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5CH6XT8QD67","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J189","Z1231","H25813","M25561","M2021","M19071","M21611","M25774","M25551","M25552","H5201","Z9841","Z98890","H2512","Z961","M5416","M654","M5450","I480","M5136","M79604","M48061","R0602","R059","S83231A","Z0000","J4520","H2513","H5703","H40051","I10","Z09","R5383","M21619","S83241A","M2391","M2022","G8929","M79672","Z79899","J45901","R053","H5203","R0789","E785","S6990XA","Z4889","N3941","M1711","D72819","R079","J4489","M810","Z13820","M79671","R051","M47816","M47817","M7072","L608","Z7951","M79661","Z1211","Z7901","R0600","Z23","B351","Z136","R0781","Z01818","R7989","M25461","N8110","I082","J069","L603","R519","A6920","M778"],"date":["2023-03-28","2024-09-13","2024-06-21","2024-02-09","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2024-07-31","2024-09-27","2024-06-21","2023-05-18","2024-03-04","2024-10-30","2024-08-29","2025-05-14","2022-12-15","2025-03-25","2025-03-31","2022-10-12","2023-08-22","2025-01-31","2025-04-10","2025-04-15","2024-02-02","2024-07-24","2024-01-16","2023-05-02","2024-10-30","2023-05-02","2023-05-02","2024-02-12","2024-05-02","2022-12-07","2023-11-03","2023-08-22","2023-05-09","2023-05-09","2023-05-09","2025-04-25","2023-03-20","2025-04-24","2023-05-30","2025-03-06","2024-07-31","2023-09-15","2024-02-06","2024-09-13","2023-08-30","2024-09-13","2023-03-28","2025-04-25","2024-05-06","2024-05-06","2022-10-14","2025-04-10","2025-01-22","2025-01-22","2025-03-25","2025-06-13","2025-04-25","2023-04-19","2024-08-27","2024-11-07","2024-01-16","2022-09-16","2024-03-20","2024-01-22","2025-02-07","2024-01-22","2023-05-25","2023-04-18","2023-03-02","2023-12-01","2024-12-20","2024-03-20","2025-07-25","2022-07-21","2022-07-21"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":""}]}]}