{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Holly Lundquist","gend":1,"currentgend":"","add":"14 HOME ST","city":"SANFORD","state":"ME","zip":"04073","dob":"1973-01-19","age":"","mstatus":"","insh":"10000077768","cliId":"","pno":2076318510,"cno":"","email":"hollyblundquist@gmail.com","ename":"","eno":"","pphy":"LORD VOSHELL, PAMELA E","ppno":6036926676,"pcpadd":"Wentworth Douglass Physician Corportion,85 Main St somersworth Plaza","pcpcity":"Somersworth","pcpstate":"NH","pcpzip":"03878","pcpcounty":"","pcpid":"","pcpname":"WHP BELLAMY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"14 HOME ST","madd2":"","madd3":"","mcity":"SANFORD","mstate":"ME","mzip":"04073","pcpfaxno":6036920919,"pcpnpi":1295067221,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6KD0WM5FY39","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79899","F3112","K760","F3160","F4310","M0609","R7982","E119","M25531","Z1211","F509","Z86010","D123","K5730","M7989","G5601","Z0000","I10","F419","R630","R7303","Z0101","H524","M25511","G8929","S6991XA","M19011","M7541","E109","F319","F1010","R6889","S76912A","R55","D72819","E878","R0602","D729","Z01419","N930","E039","D709","R0789","R0781","N3010","M7910","M069","N3090","R5383","Z794","H5213","R69","R5381","M2550","G4733","S79922A","R32","B3731","Z85528","R3982","R350","R3915","N181","Z905","F1021","R531","E1121","B370","Z1231","F3111","F39","F3162","F5081","R634","K581","M059","E1122","F349","E785","Z23","M130","F3113","F3164","Z7251","Z113","K5909","R1032"],"date":["2025-09-04","2025-10-06","2024-02-21","2025-10-23","2025-10-23","2025-09-04","2024-12-04","2025-07-07","2024-08-28","2024-03-12","2025-08-08","2024-03-12","2024-03-12","2024-03-12","2024-07-25","2025-01-15","2024-12-20","2024-12-20","2025-03-20","2024-06-13","2025-01-07","2025-06-17","2025-06-17","2024-09-04","2024-09-04","2024-08-28","2024-09-04","2024-09-04","2025-06-17","2023-12-28","2025-09-18","2023-01-19","2023-08-08","2023-08-08","2023-08-08","2023-08-11","2022-12-21","2023-08-10","2023-01-19","2023-05-02","2023-06-13","2023-09-13","2022-12-20","2022-12-20","2022-12-09","2022-12-20","2022-12-20","2023-05-22","2023-06-13","2023-05-22","2023-05-17","2023-05-22","2023-06-13","2023-06-13","2023-01-03","2023-08-08","2023-05-17","2023-01-19","2023-01-19","2023-03-21","2023-01-18","2023-01-18","2023-10-05","2023-10-05","2023-03-14","2023-03-16","2023-10-17","2023-10-17","2023-10-04","2023-03-20","2022-11-01","2022-11-16","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-08-29","2022-08-29","2022-08-17","2022-08-10","2022-08-11","2022-07-11","2022-07-25","2022-06-28","2022-06-28","2022-06-16","2022-06-16"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","SULFASALAZINE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","PRAZOSIN HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","TERCONAZOLE","","","Select","Select",""],["","","LACTULOSE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","FLULAVAL QUAD 2022-2023","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ZIPRASIDONE 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":[]}},{"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":""}]}]}