{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rachel M Michaud","gend":1,"currentgend":"","add":"15 JEPSON AVE","city":"LEWISTON","state":"ME","zip":"04240","dob":"1954-06-26","age":"","mstatus":"","insh":"10000081853","cliId":"","pno":2077834150,"cno":"","email":"","ename":"","eno":"","pphy":"WYMAN, PEGGY","ppno":2076472311,"pcpadd":"180 CHURCH HILL RD STE 1,","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 JEPSON AVE","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":2075242093,"pcpnpi":1073592283,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7R55CR3HT88","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F332","F419","N390","E1165","G4733","S0990XA","S199XXA","M51360","R42","R200","N281","K5900","I10","R0602","L03311","R21","E119","E6601","E039","E876","M793","R6510","E66813","Z135","F411","R4182","E1142","L603","B351","M79675","M79674","E113411","Z794","E113412","Z0000","Z7409","M159","F410","F4310","F4321","E113413","E1169","N289","H2512","E785","G4730"],"date":["2025-05-21","2023-11-22","2025-10-29","2025-07-25","2025-10-23","2025-08-16","2025-08-16","2025-09-03","2025-09-03","2025-09-19","2025-10-04","2025-09-15","2025-10-03","2022-12-30","2025-11-10","2025-10-16","2022-12-30","2022-12-30","2025-10-31","2025-10-08","2025-11-10","2025-11-10","2025-11-10","2024-12-19","2025-09-11","2025-10-07","2023-02-02","2023-02-02","2023-02-02","2023-02-02","2023-02-02","2023-02-01","2023-02-01","2023-02-01","2024-12-19","2024-12-19","2024-12-19","2025-09-11","2025-09-11","2025-09-11","2025-10-31","2025-01-23","2025-10-14","2022-09-19","2022-05-18","2022-04-12"],"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":[["","","NYSTATIN","","","Select","Select",""],["","","ULTRA-FINE ORIGINAL PEN NEEDLE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AUTOSHIELD DUO PEN NEEDLE","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","HUMULIN R U-500 KWIKPEN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","TRUEPLUS PEN NEEDLE","","","Select","Select",""],["","","PEN NEEDLE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","FREESTYLE TEST STRIPS","","","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":""}]}]}