{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Colleen Vannah","gend":1,"currentgend":"","add":"1434 WINSLOWS MILLS RD","city":"WALDOBORO","state":"ME","zip":"04572","dob":"1954-09-01","age":"","mstatus":"","insh":"10000079583","cliId":"","pno":2078324459,"cno":"","email":"cvannah222@gmail.com","ename":"","eno":"","pphy":"COUGHLAN, ANN M","ppno":2075634250,"pcpadd":"5 MILES CENTER WAY,UNIT 1","pcpcity":"DAMARISCOTTA","pcpstate":"ME","pcpzip":"45434067","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1434 WINSLOWS MILLS RD","madd2":"","madd3":"","mcity":"WALDOBORO","mstate":"ME","mzip":"04572","pcpfaxno":2075634561,"pcpnpi":1003997115,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4TJ2WQ0WV01","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E782","M25551","M25552","G5601","M1612","Z0100","N1831","M159","N898","K2980","I10","E785","K219","Z96642","H60501","Z7189","J309","E6601","R6889","Z471","K2960","Z4889","J329","Z01812","E669","M1711","Z1231","Z98890","Z124","Z23","G5602","M25561","M25461","Z09","Z96643","Z0000","R1319","Z01818","Z96641","G5603","K449","H109","M160","R202","R7309","E6609","Z713","Z13220"],"date":["2025-05-08","2023-10-30","2024-03-14","2023-05-10","2024-04-03","2025-06-05","2024-05-02","2023-05-05","2024-11-04","2023-10-18","2024-04-03","2024-04-03","2024-04-03","2025-04-15","2023-09-03","2022-12-02","2023-09-03","2024-07-15","2023-04-27","2024-04-18","2023-09-18","2023-04-11","2023-09-07","2024-03-14","2024-04-03","2024-07-18","2025-06-04","2024-04-03","2023-04-28","2024-09-20","2023-01-10","2024-09-20","2024-07-18","2025-04-15","2025-04-15","2025-05-08","2023-09-18","2024-03-14","2024-03-14","2022-12-12","2023-09-18","2025-02-15","2022-10-10","2022-09-08","2022-09-08","2022-06-07","2022-04-12","2022-03-08"],"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":[["","","DULOXETINE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","AFLURIA QUAD 2022-23 (3YR UP)","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2021-22","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}