{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cynthia M Malcolm","gend":1,"currentgend":"","add":"15 ROCKY PINES RD","city":"CHELSEA","state":"ME","zip":"04330","dob":"1955-06-17","age":"","mstatus":"","insh":"10000078101","cliId":"","pno":2075827764,"cno":"","email":"omalc@aol.com","ename":"","eno":"","pphy":"LIEGNER, ADAM","ppno":2075826608,"pcpadd":"4 HORTON PL,SUITE 101","pcpcity":"TOPSHAM","pcpstate":"ME","pcpzip":"40861747","pcpcounty":"","pcpid":"","pcpname":"GARDINER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 ROCKY PINES RD","madd2":"","madd3":"","mcity":"CHELSEA","mstate":"ME","mzip":"04330","pcpfaxno":2075822258,"pcpnpi":1265793574,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4J79W72WG41","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1811","A6920","F411","F3170","Z79899","F3132","F310","F439","H6991","M542","G4700","M8589","Z96691","L820","L570","F419","F3130","E785","M810","L821","B079","Z1231","L814","Z85828","Z872","R197","Z0000","Z131","F319","I10","Z1283","F32A","Z471","Z0100","D3132","Z23","L738","Z789","R202","M79651"],"date":["2023-11-02","2024-05-27","2025-10-20","2025-10-20","2025-09-09","2025-08-22","2023-10-05","2024-07-11","2024-01-11","2024-01-11","2025-09-09","2024-01-03","2023-11-02","2025-07-17","2025-07-17","2025-04-16","2025-04-16","2025-07-14","2023-01-31","2025-01-02","2025-01-02","2024-01-03","2025-01-02","2025-01-02","2025-01-02","2024-12-13","2025-03-31","2024-03-25","2025-07-15","2023-03-22","2024-01-11","2025-03-31","2024-01-09","2025-01-29","2025-01-29","2024-01-24","2022-10-19","2022-10-19","2022-09-17","2022-09-17"],"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":[["","","CLONAZEPAM","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","QUETIAPINE FUMARATE ER","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","LITHIUM CARBONATE ER","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AMITRIPTYLINE 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":""}]}]}