{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elaine J Dean","gend":1,"currentgend":"","add":"340 POND RD","city":"LEWISTON","state":"ME","zip":"04240","dob":"1945-03-26","age":"","mstatus":"","insh":"10000083878","cliId":"","pno":2072121965,"cno":"","email":"","ename":"","eno":"","pphy":"DAVIS, MARY E","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"340 POND RD","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":2077955727,"pcpnpi":1215917919,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3TR5FA6AF85","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I350","Z1231","I340","I2510","Z09","I6522","I499","M9904","M5450","M9903","I6529","I6523","R0600","Z95810","E119","I4891","I429","I10","I361","M1711","R52","J40","E785","Z23","J45909","R0602","M25561","J449","R5381","E669","J329","R918","D649","J8410","J9809","Z780","I110","Z0000","Z7689","I509","R5383","I080"],"date":["2025-11-03","2024-06-11","2025-10-17","2025-10-02","2025-02-11","2024-06-18","2025-03-20","2024-11-27","2024-11-27","2024-11-27","2024-06-18","2025-06-24","2025-03-13","2024-12-04","2025-08-07","2025-11-03","2025-11-03","2025-11-03","2023-12-21","2024-09-06","2024-09-06","2024-11-11","2024-11-11","2025-09-11","2025-09-22","2025-09-22","2024-09-04","2025-05-30","2024-05-31","2024-05-31","2023-10-16","2025-09-17","2023-10-16","2025-09-17","2025-09-17","2024-06-11","2025-03-11","2024-05-08","2025-11-04","2025-03-14","2022-10-25","2022-10-17"],"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":[["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","M-M-R II VACCINE","","","Select","Select",""],["","","VARIVAX VACCINE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","NITROSTAT","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":{"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":""}]}]}