{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rebecca Morse","gend":1,"currentgend":"","add":"22 TIBBETTS LN","city":"South China","state":"ME","zip":"04358","dob":"1956-07-16","age":"","mstatus":"","insh":"10000083634","cliId":"","pno":2076233189,"cno":"","email":"beckymorse2012@gmail.com","ename":"","eno":"","pphy":"FLETCHER, CHRISTINE","ppno":2076243800,"pcpadd":"Winthrop Family Medicine,16 Commerce Plaza Ste 3A","pcpcity":"Winthrop","pcpstate":"ME","pcpzip":"04364","pcpcounty":"","pcpid":"","pcpname":"WINTHROP FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"22 TIBBETTS LN","madd2":"","madd3":"","mcity":"South China","mstate":"ME","mzip":"04358","pcpfaxno":2076243845,"pcpnpi":1497068506,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1WE2C48TC03","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M069","R079","E119","F32A","M8580","R600","M0600","E1142","R6889","M810","L570","D485","B079","R109","I700","R932","R0602","E876","R4701","R1084","D509","R413","R059","G894","Z8616","Z13820","D6800","I10","K219","R296","Z0000","M3500","Z0100","H04123","M79604","M79605","Z79899","E785","G8929","R269","R4182","Z794","R55","R634","Z681","E538","G629","F459","M62838","U099","F419","Z8639","R946","N281","N289","K7689","K5900","J029","R251","I890","M5441","M50221","M4802","M5021","Z1231","M19041","M19042","Z7952","R42","G319","M5114","M4726","M5116","Z0001","M85859","Z780","M8589","H16232","L03114","M25532","R0789","I493","M25561","Z79891","D680"],"date":["2024-06-10","2023-05-11","2025-08-21","2025-06-24","2022-11-28","2023-05-16","2025-04-09","2025-02-14","2023-11-14","2025-09-09","2025-04-30","2024-04-29","2023-05-30","2023-01-18","2023-01-18","2023-01-18","2023-05-16","2024-09-30","2023-01-03","2023-01-03","2023-01-03","2025-07-17","2025-02-25","2022-11-04","2023-01-13","2024-10-01","2025-07-15","2025-07-23","2024-12-12","2023-03-02","2023-05-02","2023-10-16","2025-02-06","2025-08-11","2023-05-11","2023-05-11","2025-04-16","2025-01-13","2023-08-01","2023-03-20","2022-12-27","2022-12-27","2025-07-17","2025-07-17","2025-07-17","2024-06-17","2023-02-22","2023-01-18","2023-02-22","2023-02-17","2023-02-17","2022-11-25","2022-11-25","2025-08-04","2025-07-02","2025-07-02","2025-07-02","2024-02-19","2023-01-13","2024-12-12","2023-11-29","2023-03-25","2023-03-25","2023-03-25","2024-05-22","2022-10-10","2022-10-10","2023-06-19","2022-12-27","2022-12-27","2023-11-15","2023-11-15","2023-11-15","2024-12-12","2024-10-01","2024-10-01","2024-10-01","2025-08-11","2022-09-22","2022-08-12","2022-06-18","2022-06-06","2022-05-23","2022-05-09","2022-04-11"],"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":[["","","FLUOROURACIL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","NOVOLIN N FLEXPEN","","","Select","Select",""],["","","METHOTREXATE SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","KINERET","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANC DEV","","","Select","Select",""],["","","ONETOUCH DELICA","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","AMOXICILLIN","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}