{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Laurel S Jerry","gend":1,"currentgend":"","add":"10 PATRICIA AVE","city":"RAYMOND","state":"ME","zip":"04071","dob":"1955-04-08","age":"","mstatus":"","insh":"10000076113","cliId":"","pno":2076556253,"cno":2073104116,"email":"jetstreamjerry@maine.rr.com","ename":"","eno":"","pphy":"PIERCE, DANIEL C","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":"10 PATRICIA AVE","madd2":"","madd3":"","mcity":"RAYMOND","mstate":"ME","mzip":"04071","pcpfaxno":2078741483,"pcpnpi":1861451080,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8YG6AY9AX42","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5136","R32","M6281","M955","Z0000","M25561","Z96651","M25661","M25461","T8482XA","Y792","I10","E785","M25551","M25552","M79651","M79652","M2560","M25469","M1711","J939","Z01812","Z471","Z23","M170","M25562","M542","M2569","S161XXD","M7910","S83241A","S270XXA","Z01818","G8929","M1712","R309","Z4682","J9811","G8918","E669","R4182","R6889","S2241XA","Z1231","M1612","M7062","M7751","M5450","M1611","M25511","L609","S2241XD","L821","L570","M25572","Z1211","D120","D122","K5730","M9900","M9901","M9902","M23321","M19011","L0390","S3991XA","S3993XA","Z09","R7309","Z4789","H43393","Z780","J982","S199XXA","M898X1","R079","M7061","Z0101","V892XXA","J9809","S0990XA","R519","R0789","F439","R011","M62838","Z03818","Z0184","L723","L659"],"date":["2023-03-01","2023-03-01","2023-10-10","2023-03-01","2024-08-28","2024-11-04","2025-06-18","2024-11-04","2024-11-04","2024-08-22","2024-08-22","2024-08-22","2024-10-31","2025-10-09","2025-10-09","2025-10-09","2025-10-09","2023-10-10","2023-10-10","2024-05-13","2024-12-15","2024-04-29","2025-06-18","2025-10-28","2023-11-15","2025-11-05","2025-11-13","2025-11-13","2025-11-13","2025-05-30","2023-11-01","2024-12-16","2023-12-04","2023-12-04","2025-11-05","2025-04-14","2024-12-19","2024-12-19","2024-08-22","2024-08-22","2024-05-13","2023-11-29","2024-12-27","2025-06-16","2025-07-22","2025-09-02","2023-03-14","2025-07-22","2025-07-22","2025-02-13","2025-02-13","2025-02-13","2024-01-23","2024-01-23","2023-02-07","2025-05-19","2025-05-19","2025-05-19","2025-05-19","2024-12-19","2024-12-19","2024-12-19","2023-10-26","2025-02-07","2024-02-05","2024-12-15","2024-12-15","2025-06-18","2024-10-31","2024-09-06","2025-10-14","2023-08-25","2024-12-17","2024-12-15","2025-02-07","2022-12-20","2025-09-02","2024-10-09","2024-12-15","2024-12-18","2024-12-15","2025-10-07","2022-10-30","2022-10-30","2022-10-30","2022-10-31","2022-10-14","2022-08-02","2021-12-28","2021-12-28"],"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":[["","","AMOXICILLIN","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","PFIZER 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":""}]}]}