{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carol A Saucier","gend":1,"currentgend":"","add":"72 Littlefield Pond Rd","city":"Limington","state":"ME","zip":"04049","dob":"1956-01-03","age":"","mstatus":"","insh":"10000084657","cliId":"","pno":2072982710,"cno":"","email":"","ename":"","eno":"","pphy":"Gene M Royer","ppno":2076258126,"pcpadd":"253 Bridgton Rd,","pcpcity":"Fryeburg","pcpstate":"ME","pcpzip":"40371438","pcpcounty":"","pcpid":"","pcpname":"Sacopee Valley Health Center","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"Po Box 66","madd2":"","madd3":"","mcity":"Limington","mstate":"ME","mzip":"04049","pcpfaxno":2076257820,"pcpnpi":1992776017,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4EP6GQ7GD82","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N398","R339","N393","N952","J339","I10","E785","Z6829","M85852","Z98890","D140","J342","J343","Z79899","J40","R5383","Z87891","Z1231","R0600","R0902","Z0101","H26491","Z23","J441","J9601","K08531","B338","F17210","J0101","Z6830","R0609","J329","E039","Z0000","F419","N951","M542","M5450","R799","R7309","Z961","J069","Z780","Z6828","J9811","J439","R0602","R918","Z122","M25551","J0100","J208","R3915"],"date":["2025-02-27","2025-02-27","2025-02-27","2025-02-27","2024-05-03","2025-06-30","2025-08-11","2025-06-30","2023-02-28","2024-05-03","2025-01-14","2024-04-26","2024-04-26","2024-09-16","2023-06-22","2023-06-22","2025-04-24","2025-01-10","2024-01-02","2024-03-14","2022-11-23","2023-02-02","2024-12-30","2024-01-12","2024-01-12","2023-07-26","2024-01-09","2024-01-09","2025-03-11","2025-03-11","2024-02-28","2024-03-11","2024-03-07","2024-12-30","2024-12-30","2022-12-23","2023-11-27","2023-11-27","2022-12-20","2022-12-20","2023-02-02","2023-02-06","2023-02-28","2024-01-02","2024-01-06","2025-04-24","2024-01-02","2023-04-21","2023-03-23","2022-09-20","2025-01-20","2025-01-20","2024-05-16"],"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":[["","","HYDROXYZINE HCL","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MOXIFLOXACIN HCL","","","Select","Select",""],["","","BETHANECHOL CHLORIDE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","PAXLOVID (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":[]}},{"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":""}]}]}