{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Julie J Mishoe","gend":1,"currentgend":"","add":"28 DAVID RD","city":"PORTLAND","state":"ME","zip":"04102","dob":"1954-05-07","age":"","mstatus":"","insh":"10000083575","cliId":"","pno":2077611820,"cno":"","email":"jjmish@msn.com","ename":"","eno":"","pphy":"LOISELLE, DANIEL","ppno":2077745816,"pcpadd":"100 FODEN ROAD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 DAVID RD","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04102","pcpfaxno":2078741483,"pcpnpi":1316906589,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5NC1VJ5RQ02","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R399","M2041","M2042","L84","M7741","S0003XA","Z9181","S93401A","F418","Z96642","L570","M25562","S76219A","Z96649","D487","Z471","F331","Z8639","I480","R1032","A6000","R5383","M6289","M79644","Z1211","M19072","M79672","M7672","M6580","R051","Z0000","J029","U099","M722","D2121","M79671","R6889","M25552","S90819A","Z1231","J101","J40","S99921D","M7582","M7542","Z0101","M19041","S60459A","M9901","M5413","M436","M542","S6991XD","F419","F411","R002","I4891","Z23","S61214A","F450","R042","R58"],"date":["2023-09-26","2024-07-25","2024-07-25","2024-07-25","2024-07-25","2025-01-23","2025-01-23","2025-01-23","2025-05-05","2024-06-10","2024-02-07","2024-08-31","2023-03-24","2023-03-24","2023-07-05","2024-04-18","2025-05-05","2025-05-05","2025-09-10","2023-09-26","2023-06-13","2025-09-04","2025-09-04","2023-10-16","2024-03-13","2023-06-15","2023-06-15","2023-06-15","2023-03-31","2023-08-21","2024-11-25","2023-08-21","2023-08-21","2023-05-01","2023-05-01","2023-05-01","2023-04-27","2024-06-11","2023-08-13","2023-05-03","2025-01-09","2025-01-09","2025-01-25","2024-11-04","2024-11-04","2024-09-23","2023-10-07","2022-03-18","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-21","2022-01-12","2021-12-01","2022-02-07","2021-12-23","2021-12-31","2021-12-31","2022-01-12","2022-02-09","2022-02-10"],"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":[["","","AMOXICILLIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","FLUOROURACIL","","","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":""}]}]}