{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Denise C Leavitt","gend":1,"currentgend":"","add":"76 SHOREYS BROOK LN","city":"ELIOT","state":"ME","zip":"03903","dob":"1952-06-23","age":"","mstatus":"","insh":"10000078234","cliId":"","pno":2076980125,"cno":"","email":"deniseleavitt52@gmail.com","ename":"","eno":"","pphy":"HASSETT, VIRGINIA K","ppno":6036096800,"pcpadd":"789 CENTRAL AVE,","pcpcity":"DOVER","pcpstate":"NH","pcpzip":"38202526","pcpcounty":"","pcpid":"","pcpname":"WHP INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"76 SHOREYS BROOK LN","madd2":"","madd3":"","mcity":"ELIOT","mstate":"ME","mzip":"03903","pcpfaxno":"","pcpnpi":1578552113,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9YC9T68YC21","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E7849","Z961","Z780","Z124","E1122","E1165","I214","G4733","G4730","Z1231","M436","R300","Z794","R0609","I2510","H43811","E113393","R0602","E042","H25812","M542","M47812","M7918","E1121","Z9641","I10","M170","R221","M25551","R918","H43813","D3131","E119","M47816","R079","I160","H25813","H269","H259","I4510","R9431","M79671","R200","M79672","I252","Z951","M2041","M2042","E109","N200","R350","R9439","C186","I129","M159","H20012","H25811","H02054","E1149","E782","Z0000","I4891","M79601","N898","R0789","Z20822","I5032","R8290","Z96642","M25569","M25559","I2720","J849","Z0100","E113293","M4802","E1159","E118","I480","E1136","I119","M150","E6601","Z1211","Z85038","D127","K5730","Z86010","K621","K317","M25561","I639","Z7901","N1831"],"date":["2023-02-21","2024-06-05","2023-12-29","2024-12-26","2024-11-04","2025-09-16","2023-03-01","2025-07-25","2025-07-25","2023-12-12","2023-11-02","2025-03-25","2025-09-09","2025-07-31","2025-03-12","2024-03-06","2024-05-09","2024-05-03","2025-09-09","2023-08-05","2024-10-29","2025-01-06","2024-11-22","2025-09-09","2025-08-05","2023-09-25","2023-05-09","2022-12-06","2023-05-09","2025-06-24","2024-06-05","2024-06-05","2025-05-12","2024-06-12","2024-04-18","2022-10-04","2023-07-21","2023-10-03","2023-06-16","2024-05-27","2024-05-27","2023-06-22","2023-06-22","2023-06-22","2023-03-29","2024-07-10","2023-05-03","2023-05-03","2023-05-03","2023-10-18","2023-10-18","2024-07-10","2022-11-14","2024-11-04","2024-11-04","2025-06-12","2023-10-03","2025-06-17","2023-08-07","2023-08-07","2023-08-07","2022-10-28","2023-09-22","2024-12-26","2022-10-04","2022-10-04","2024-07-22","2024-12-23","2023-05-09","2023-05-09","2023-05-09","2025-07-31","2025-07-31","2025-06-09","2025-06-09","2025-01-06","2022-10-11","2024-04-03","2022-08-15","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-06-28","2022-06-28","2022-06-28","2022-06-28"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ADMELOG","","","Select","Select",""],["","","INPEN (FOR NOVOLOG OR FIASP)","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FREESTYLE PRECISION NEO","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","NOVOLOG PENFILL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","POTASSIUM CITRATE ER","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","ADMELOG SOLOSTAR","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FIASP FLEXTOUCH","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","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":""}]}]}