{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jayne J Libbey","gend":1,"currentgend":"","add":"45 OCEAN GREENS DR","city":"SACO","state":"ME","zip":"04072","dob":"1955-04-14","age":"","mstatus":"","insh":"10000076429","cliId":"","pno":2073565352,"cno":"","email":"bowdoinmom@gmail.com","ename":"","eno":"","pphy":"TOPPEN, LINDSAY E","ppno":2072823349,"pcpadd":"SMHC Internal Medicine,46 Barra Rd Ste 201","pcpcity":"Biddeford","pcpstate":"ME","pcpzip":"04005","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"45 OCEAN GREENS DR","madd2":"","madd3":"","mcity":"SACO","mstate":"ME","mzip":"04072","pcpfaxno":2072943541,"pcpnpi":1235600693,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5MG8PH1NF67","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","F419","M8580","C50511","Z170","L720","L738","L821","M8589","N644","F411","R921","I340","D352","R110","I517","E1165","F331","F418","E782","R0789","Z853","Z0000","R922","N6012","Z1239","Z08","L570","D229","L578","L814","D225","Z0100","I10","M8588","F3342","L718","R6889","J0190","H6692","R051","J029","J069","N6322","Z136","E663","B029","Z7984","N6489","Z1211","K5730","D128","Z86010","L709","K621","K449","K6389"],"date":["2025-04-21","2025-06-12","2025-10-03","2025-10-03","2025-10-03","2023-06-08","2023-06-08","2024-11-26","2025-05-13","2024-10-04","2025-11-05","2025-02-06","2024-09-06","2025-01-29","2025-01-29","2024-09-06","2025-05-12","2025-05-12","2025-05-12","2025-06-17","2025-06-17","2025-02-06","2025-03-24","2023-02-21","2023-03-23","2023-09-28","2023-02-21","2024-11-26","2023-12-13","2024-11-26","2024-11-26","2024-11-26","2025-04-21","2024-06-12","2025-05-13","2024-08-27","2024-05-29","2023-07-07","2024-02-25","2023-04-13","2023-04-13","2023-04-13","2023-04-13","2023-09-28","2025-06-17","2023-10-11","2025-10-18","2024-06-12","2022-09-22","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-07","2022-06-17","2022-06-17","2022-06-17"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}