{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy A Dennison","gend":1,"currentgend":"","add":"44 BROOKSIDE DR","city":"NEW GLOUCESTER","state":"ME","zip":"04260","dob":"1955-08-30","age":"","mstatus":"","insh":"10000078182","cliId":"","pno":2076534102,"cno":"","email":"ndennisonn@yahoo.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":"44 BROOKSIDE DR","madd2":"","madd3":"","mcity":"NEW GLOUCESTER","mstate":"ME","mzip":"04260","pcpfaxno":2078741483,"pcpnpi":1861451080,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6MU8YY5MR66","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47812","R202","M542","F329","F331","G43909","M5412","R413","Z20822","D3502","L570","L658","L578","L814","R7303","D3131","H04123","G4710","G4719","R0683","R0789","R079","Z8616","H02811","N3946","M6281","G90A","N952","R0602","R42","G43911","Z0001","N8110","N958","N816","Z0000","G43719","G47419","G4711","Z1231","J0110","R232","M8580","E278","J9811","Z6827","R053","U099","R944","R5383","M8588","H5203","I2510","L820","R6889","Z803","J069","N200","K5732","E663","H16223","K5792","R4182","I10","E785","Z23","B079","L259","D485","K5900","Z8673","R519","G9389","G43901","R110","R0600","K130"],"date":["2024-07-15","2024-05-20","2024-05-20","2023-12-01","2024-01-31","2025-10-30","2023-11-13","2025-05-20","2023-02-04","2023-07-28","2025-04-23","2023-03-22","2023-03-22","2023-03-22","2024-11-04","2025-09-10","2024-06-05","2023-08-09","2023-08-09","2023-08-08","2024-08-08","2024-08-08","2023-06-25","2024-05-24","2024-12-16","2024-12-16","2024-06-17","2025-02-12","2025-06-26","2023-04-28","2025-10-30","2025-05-23","2025-05-09","2025-05-09","2025-05-09","2024-08-07","2023-05-30","2023-05-11","2023-07-20","2025-01-17","2023-07-10","2023-05-18","2025-05-20","2023-08-14","2023-07-21","2024-08-07","2023-07-21","2023-07-21","2024-08-19","2023-07-10","2025-01-17","2025-10-21","2024-08-08","2024-10-25","2023-10-04","2024-12-03","2024-04-12","2022-12-15","2022-12-15","2024-07-09","2025-10-21","2022-12-15","2023-08-15","2025-05-20","2025-05-20","2024-11-11","2022-11-04","2022-09-02","2022-09-02","2022-07-20","2022-06-02","2022-05-26","2022-05-26","2022-05-11","2022-04-24","2021-12-10","2021-12-16"],"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":[["","","MOUNJARO","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","MINOXIDIL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","NARATRIPTAN HCL","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","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":""}]}]}