{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Margaret M Cunniff","gend":1,"currentgend":"","add":"27 NORTHWOOD RD","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1950-02-25","age":"","mstatus":"","insh":"10000075715","cliId":"","pno":2077496577,"cno":"","email":"mcunniff225@gmail.com","ename":"","eno":"","pphy":"BUSTAMANTE, ANTHONY","ppno":2078469013,"pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"27 NORTHWOOD RD","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2075238586,"pcpnpi":1306229521,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9VV5MJ9KC66","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25512","Z1211","D120","Z860101","D122","G8929","M7542","Z0101","M4802","M47812","Z0001","E1122","E1159","I10","N1831","M542","M75102","M19012","M5412","M75112","Z1231","M19032","M25552","S199XXA","M67959","M6281","M2560","E1165","Z23","E8342","E559","Z0000","M25532","M19042","H3554","E119","R058","J069","Z5181","M1612","M47816","H6123","Z03818","R6889","E782","R052","Z800","D123","D125","M76812","L03116"],"date":["2025-07-25","2025-06-03","2025-06-03","2025-06-03","2025-06-03","2025-07-25","2025-07-25","2025-04-30","2025-04-22","2025-10-27","2025-03-13","2025-09-09","2025-03-04","2025-03-04","2025-03-04","2025-10-27","2025-10-22","2025-09-24","2025-11-17","2025-07-25","2025-05-02","2023-04-04","2023-06-13","2024-01-12","2023-03-30","2023-03-30","2023-03-30","2023-09-05","2024-10-03","2023-01-12","2022-12-23","2022-12-23","2023-04-04","2023-04-04","2024-04-25","2024-04-25","2023-09-26","2023-09-26","2023-10-12","2023-05-22","2022-12-23","2022-10-03","2022-10-03","2022-05-17","2022-10-21","2022-10-14","2022-05-03","2022-05-03","2022-05-03","2022-04-14","2021-12-10"],"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":[["","","OZEMPIC","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}