{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janice M Gaudet","gend":1,"currentgend":"","add":"12 GRANITE DR","city":"FALMOUTH","state":"ME","zip":"04105","dob":"1954-05-19","age":"","mstatus":"","insh":"10000080345","cliId":"","pno":2078072196,"cno":"","email":"mimigaudett@yahoo.com","ename":"","eno":"","pphy":"KIM, REGINA Y","ppno":2075351340,"pcpadd":"MERCY WEST FALMOUTH PRIMARY CARE,75 GRAY RD","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"04105","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 GRANITE DR","madd2":"","madd3":"","mcity":"FALMOUTH","mstate":"ME","mzip":"04105","pcpfaxno":2075351358,"pcpnpi":1104906155,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1T80R42RA07","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","J329","J3489","I4819","J439","J449","J438","I4891","Z87891","M9904","M542","M9901","I5032","M5136","J8489","G4733","M62830","R918","R059","R0902","I517","I10","J9611","Z79899","I081","R600","I83813","M47816","M25561","I440","I480","I4720","R008","M48061","R053","Z01810","I484","J342","K5900","R112","D485","R208","D1801","L821","L720","L814","Z23","Z09","M23341","M1711","M25461","E7800","Z1231","R0602","I25711","I340","I5189","B309","E785","N281","M4186","I110","I441","I493","R002","D225","K8020","R5383","Z01811","J189","J45909","M25562","G8929","Z0001","J45998","E871","M5450","Z0000","R0609","U099","J069","I088","I499","R911","Z5189","M9909","M1712","R0600","H6123","H9313","H903"],"date":["2024-11-19","2024-05-24","2024-02-23","2025-07-24","2025-11-16","2024-11-29","2024-10-15","2025-01-15","2024-10-15","2025-11-05","2025-11-05","2025-11-05","2025-10-22","2024-09-25","2023-12-18","2025-10-24","2025-06-17","2025-11-16","2023-12-10","2023-12-10","2025-01-15","2025-03-13","2025-05-11","2025-03-17","2025-07-24","2024-11-22","2023-08-10","2025-10-06","2025-11-09","2025-02-14","2024-10-28","2024-09-11","2024-09-11","2025-10-06","2025-11-07","2025-02-14","2025-02-18","2023-12-11","2023-12-10","2023-12-10","2025-10-23","2025-10-23","2025-10-23","2025-10-23","2025-10-23","2025-10-23","2024-02-15","2023-12-22","2025-11-09","2025-11-09","2025-11-09","2024-03-08","2025-05-01","2024-10-15","2023-02-13","2024-10-17","2024-10-25","2023-12-04","2025-04-11","2025-11-12","2025-06-17","2023-12-06","2024-10-01","2024-10-01","2024-09-25","2025-10-23","2025-11-12","2022-11-28","2025-02-11","2024-01-22","2025-06-04","2025-10-29","2025-10-29","2025-04-17","2025-06-03","2023-12-20","2024-03-18","2022-12-09","2022-12-09","2022-12-09","2023-03-06","2024-09-25","2024-09-25","2023-06-29","2024-02-01","2024-03-14","2025-11-07","2022-09-01","2022-07-07","2022-07-07","2022-07-07"],"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":[["","","SPIRONOLACTONE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","TEZSPIRE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CARTIA XT","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO 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":{"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":""}]}]}