{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lorraine W Day","gend":1,"currentgend":"","add":"75 STATE STREET UNIT 118","city":"Portland","state":"ME","zip":"04101","dob":"1955-08-13","age":"","mstatus":"","insh":"10000078744","cliId":"","pno":2076157746,"cno":"","email":"BB58LD55@OUTLOOK.COM","ename":"","eno":"","pphy":"GORMAN, ALISON C","ppno":2078742141,"pcpadd":"180 PARK AVE,PORTLAND COMMUNITY HEALTH CENTER","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41022957","pcpcounty":"","pcpid":"","pcpname":"PORTLAND COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"75 STATE STREET UNIT 118","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04101","pcpfaxno":2078742164,"pcpnpi":1891710844,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9UX6AY0MX74","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z7189","I10","E039","N1832","R42","Z0000","G4733","K559","E538","R0602","D509","E6601","D508","Z1231","G4721","R52","Z8639","F319","D649","M25551","Z0100","J9811","J984","R918","R1902","R109","Z9081","G319","Z9884","L989","Z23","M7061","Z1211","Z7409","R0600","N3946","M1990","Z7982","Z87891","E875","D75839","M160","B372","K219","E8351","Z86010","F418","K5909","Z8719","K909","N189","R7989"],"date":["2025-05-12","2024-11-25","2024-11-25","2024-10-21","2023-06-26","2024-10-21","2025-08-19","2025-08-08","2025-10-20","2025-10-20","2025-06-12","2025-06-30","2023-11-14","2023-03-23","2024-06-05","2023-09-13","2024-06-17","2023-06-15","2024-03-28","2024-08-05","2024-06-28","2025-08-22","2025-08-22","2025-08-22","2025-08-22","2024-05-19","2024-05-19","2024-05-19","2024-05-19","2025-08-11","2025-04-14","2023-03-31","2024-06-26","2024-05-13","2025-08-22","2023-09-25","2023-03-29","2023-03-29","2025-05-23","2024-10-21","2025-05-23","2023-03-29","2025-04-14","2024-05-28","2024-04-01","2024-06-26","2024-06-26","2024-08-05","2024-08-05","2023-05-15","2024-04-01","2022-08-11"],"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":[["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}