{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sherry L Cahoon","gend":1,"currentgend":"","add":"1 WOODBURY ST","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1955-09-26","age":"","mstatus":"","insh":"10000079056","cliId":"","pno":2077510837,"cno":"","email":"jlcslc22@gmail.com","ename":"","eno":"","pphy":"KU RUTH, PHYLLIDIA M","ppno":2077745816,"pcpadd":"100 FODEN RD W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062319","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1 WOODBURY ST","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078741483,"pcpnpi":1497724108,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3JX7XG5EA66","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N390","N3000","N952","R051","Z0101","J984","Z23","E039","D72819","F419","J449","R079","U071","R509","Z03818","J111","M810","R399","R6889","M24571","R899","Z8616","Z636","L821","L814","I781","R300","M8588","Z0000","D2272","Z872","M792","E7800","M79671","M21611","M7741","R3129","Z87440","Z0100","Z853","E042","M9900","M9901","M9902","M79621","R8290","M542","M79651","R310","Z20828","Z1501"],"date":["2025-03-19","2023-07-07","2023-07-07","2023-03-02","2023-11-16","2023-03-02","2025-09-18","2024-11-26","2024-11-26","2025-03-31","2024-08-08","2024-08-09","2024-08-09","2025-03-06","2025-03-06","2025-03-06","2025-10-06","2025-02-21","2023-11-21","2025-01-08","2024-08-14","2024-08-14","2024-08-14","2025-07-08","2025-07-08","2025-07-08","2025-01-28","2025-09-05","2024-12-05","2023-07-11","2023-07-11","2024-12-13","2024-11-26","2024-11-07","2024-11-07","2024-11-20","2025-02-28","2025-02-22","2024-12-26","2022-11-01","2022-11-01","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-08-09","2022-08-09","2022-08-25","2022-08-17","2022-07-30","2022-08-04"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","LEVOXYL","","","Select","Select",""],["","","NITROFURANTOIN","","","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":""}]}]}