{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gail E Ouellette","gend":1,"currentgend":"","add":"195 MOUNTAIN RD","city":"Alfred","state":"ME","zip":"04002","dob":"1955-05-13","age":"","mstatus":"","insh":"10000076435","cliId":"","pno":2073241469,"cno":"","email":"declined@011425.com","ename":"","eno":"","pphy":"BREAULT, TERESA M","ppno":2076768559,"pcpadd":"7 HIGH ST,","pcpcity":"NORTH BERWICK","pcpstate":"ME","pcpzip":"39066100","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"195 MOUNTAIN RD","madd2":"","madd3":"","mcity":"Alfred","mstate":"ME","mzip":"04002","pcpfaxno":2076760982,"pcpnpi":1447211073,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9DK6P08VU42","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z08","R350","S52135D","R6889","H16041","H47233","H3540","H11043","H25813","Z0000","E782","M810","N951","Z0101","H5213","Z853","Z98890","Z1231","H16042","R3129","L814","L821","M7130","L578","L570","S20362A","H18523","Z85828","M25422","S4992XA","R3121","H40003","W57XXXA","M25522","S52135A","E559","S52392A","M67441","H40013","H40043","H18593","H2513","M6748","M67411","E785","F329","R4182","M778","M19041","M79641"],"date":["2024-02-13","2024-11-06","2025-04-16","2023-06-29","2024-06-12","2023-03-21","2023-03-21","2023-03-21","2023-03-21","2025-06-27","2025-06-27","2025-07-01","2024-07-29","2025-08-11","2024-06-26","2024-02-13","2024-02-13","2025-02-21","2025-07-30","2024-09-16","2025-03-18","2025-03-18","2024-03-19","2024-03-19","2025-03-18","2023-07-10","2024-04-27","2025-03-18","2025-02-28","2025-03-05","2024-11-06","2025-08-11","2023-07-10","2025-02-28","2025-02-28","2025-06-27","2025-02-28","2022-08-03","2022-06-24","2022-06-24","2022-06-24","2022-06-24","2022-07-28","2022-08-03","2022-08-03","2022-08-03","2022-08-03","2022-08-03","2022-07-28","2022-04-26"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","FLUZONE QUAD 2022-2023","","","Select","Select",""],["","","TRAMADOL HCL","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}