{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Laura I Morris","gend":1,"currentgend":"","add":"53 BOWERY BEACH RD","city":"CAPE ELIZABETH","state":"ME","zip":"04107","dob":"1956-02-07","age":"","mstatus":"","insh":"10000084060","cliId":"","pno":2076538631,"cno":"","email":"DONEGALLIM@YAHOO.COM","ename":"","eno":"","pphy":"PATCH, JEFFREY S","ppno":2078469013,"pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"53 BOWERY BEACH RD","madd2":"","madd3":"","mcity":"CAPE ELIZABETH","mstate":"ME","mzip":"04107","pcpfaxno":2078741483,"pcpnpi":1720067317,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2P35NN9YJ89","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25511","M75121","M9907","H353221","H35372","H35052","J3089","J3081","J301","M19011","M7541","J320","K219","K589","Z79899","G8918","I10","M25862","K2970","K317","R1013","J302","H35411","M12811","Z4789","R309","L2089","Z85828","L720","L570","E785","Z86010","M67813","M7551","H43391","H353133","M25562","Z1231","Z0000","M75100","M47814","H43811","M546","E669","Z6830","R0981","R519","J0190","B9689","M19041","M720","Z0100","Z961","R110","H2511","D485","L820","L578","J0110","S4351XA","K30","Z800","D235","J329","Z23","R030","N9410","R102","N952","Z87440","L918","L723","L738","Z460","H5319","H3561","T7840XA","L814"],"date":["2025-07-11","2025-07-11","2025-07-11","2025-10-06","2024-08-06","2025-07-25","2023-02-15","2023-02-15","2023-02-15","2025-01-02","2025-01-02","2025-05-02","2025-04-10","2025-04-10","2024-12-05","2025-01-02","2025-10-09","2023-11-28","2023-07-27","2023-07-27","2023-06-06","2023-01-17","2023-04-20","2024-11-14","2025-02-17","2024-09-17","2023-09-07","2023-09-07","2023-09-07","2024-12-04","2025-10-09","2024-05-24","2024-11-14","2025-01-02","2025-07-25","2025-07-25","2023-11-28","2025-11-06","2025-10-17","2025-07-08","2024-08-22","2023-06-14","2024-08-22","2024-08-22","2024-08-22","2025-07-08","2025-07-08","2025-02-17","2025-02-17","2024-01-18","2024-01-18","2024-10-01","2024-10-01","2023-06-06","2025-10-06","2024-12-04","2024-12-04","2024-12-04","2025-01-17","2025-01-02","2024-05-24","2024-05-24","2024-12-04","2025-03-02","2022-08-10","2022-09-02","2022-09-01","2022-09-01","2022-09-01","2022-09-01","2022-08-24","2022-08-24","2022-08-24","2022-06-08","2022-06-08","2022-06-08","2022-05-17","2022-05-17"],"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":[["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","YUVAFEM","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","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":""}]}]}