{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dianne R Baietti","gend":1,"currentgend":"","add":"7 SEABURY LANE","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1953-07-18","age":"","mstatus":"","insh":"10000080133","cliId":"","pno":2077497074,"cno":"","email":"drbaietti@gmail.com","ename":"","eno":"","pphy":"NEWCOMBE, JODI A","ppno":2075351200,"pcpadd":"385 ROUTE 1,","pcpcity":"YARMOUTH","pcpstate":"ME","pcpzip":"40966729","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE YARMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 SEABURY LANE","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2075351249,"pcpnpi":1114339611,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3WH3PR4WC06","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25551","M25651","M25351","R2689","E785","I10","Z85820","R7303","Z471","M25561","M25512","M25612","M25661","H903","H9313","M2170","M7630","M7060","Z96641","Z1231","Z0100","R6889","M1611","I2510","R911","H6983","L570","L814","L578","H6691","D492","T162XXA","I071","H938X3","U071","Z0000","H04123","M25461","H6990","L820","I4510","K120","H6981","F331","S70362A","H65191","H6993","H9190","H9203","H905","J34829","R61","Z23","M21751","L821","L308","Z1211","L439","Z20822","Z0001","R200","Z7182","Z713"],"date":["2025-09-10","2025-06-06","2025-06-06","2025-10-30","2025-08-27","2024-01-22","2024-06-06","2023-12-07","2025-09-25","2025-05-07","2024-10-08","2024-10-08","2024-10-08","2025-07-29","2025-07-29","2025-09-30","2025-09-30","2025-09-30","2025-10-30","2024-12-26","2025-08-25","2023-11-29","2025-08-27","2025-08-27","2025-08-27","2024-12-02","2024-06-06","2024-06-06","2024-06-06","2024-04-09","2025-06-26","2025-04-11","2025-07-30","2024-08-01","2024-08-01","2025-07-24","2023-06-26","2025-05-07","2024-07-09","2024-06-06","2025-08-05","2025-08-28","2025-01-17","2025-01-08","2024-05-10","2024-04-18","2024-04-18","2024-04-18","2024-10-15","2024-10-15","2024-10-15","2023-02-14","2024-12-13","2025-10-30","2025-06-26","2023-12-04","2025-08-21","2022-11-07","2022-09-19","2022-08-16","2022-08-16","2022-08-16","2022-08-16"],"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":[["","","ESTRADIOL (ONCE WEEKLY)","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}