{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna L Hemingway","gend":1,"currentgend":"","add":"179 PLEASANT ST","city":"CANTON","state":"ME","zip":"04221","dob":"1955-07-27","age":"","mstatus":"","insh":"10000082100","cliId":"","pno":2075972797,"cno":"","email":"donnahemingway@hotmail.com","ename":"","eno":"","pphy":"KING, JESSICA S","ppno":2075624226,"pcpadd":"Elsemore Dixfield Family Medicine,146 Weld St","pcpcity":"Dixfield","pcpstate":"ME","pcpzip":"04224","pcpcounty":"","pcpid":"","pcpname":"ELSEMORE DIXFIELD FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"179 PLEASANT ST","madd2":"","madd3":"","mcity":"CANTON","mstate":"ME","mzip":"04221","pcpfaxno":5188242388,"pcpnpi":1649615923,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5AN5RJ4GM58","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E039","L821","D225","M810","Z0101","H5203","I7389","B351","M79674","M79675","M19041","M1812","M47816","M5136","R2681","M5450","R400","N390","M130","G4700","L600","G629","D235","I4891","N3091","R002","Z85828","M79671","M79672","M19072","M21612","M779","M19071","R300","M1990","Z13820","Z0000","L03032","L03031","Z23","J45909","G9059","M797","I10","R0609","R0602","Z87891","I739","Z1212","Z1211","Z09","C44519","R42"],"date":["2025-10-14","2025-09-30","2025-11-11","2025-05-22","2023-06-26","2023-06-26","2025-08-25","2025-10-23","2025-10-23","2025-10-23","2023-10-23","2023-10-23","2023-10-23","2023-10-23","2023-10-23","2023-10-23","2025-01-30","2025-04-19","2023-10-19","2025-01-30","2025-10-23","2025-09-22","2025-11-11","2025-08-27","2023-02-19","2024-03-25","2025-04-19","2025-03-20","2025-03-20","2023-10-23","2023-10-23","2023-10-23","2023-10-23","2023-03-10","2025-05-22","2025-05-22","2025-10-31","2025-03-20","2025-03-20","2023-09-25","2023-09-25","2023-09-25","2024-09-25","2023-09-25","2023-11-09","2024-03-07","2024-05-30","2024-02-16","2025-01-25","2025-01-25","2025-08-27","2025-06-17","2023-05-23"],"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":[["","","DILTIAZEM HCL","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","MECLIZINE HCL","","","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":""}]}]}