{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beverly J Dusseault","gend":1,"currentgend":"","add":"11 PLEASANT HILL RD","city":"LIMERICK","state":"ME","zip":"04048","dob":"1956-05-31","age":"","mstatus":"","insh":"10000085096","cliId":"","pno":2072069272,"cno":"","email":"pbdusseault17@gmail.com","ename":"","eno":"","pphy":"CORNELIO, MARCO C","ppno":2072831441,"pcpadd":"PO BOX 99,","pcpcity":"LINCOLN","pcpstate":"ME","pcpzip":"44570099","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 PLEASANT HILL RD","madd2":"","madd3":"","mcity":"LIMERICK","mstate":"ME","mzip":"04048","pcpfaxno":2077946777,"pcpnpi":1902125909,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8VX8R47WJ24","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I639","M67912","H259","M75102","I63411","E119","Z0101","Z1231","N3946","M6289","M25512","R6889","G5621","H2511","N9089","M659","G8918","R300","N760","R42","Q2112","Z23","R4701","I10","E669","R0602","E042","I6389","R32","R5383","I8002","N6489","S46912A","M8588","N6453","M79605","I8001","J0190","Z13820","N763","N952","K649","S46012A","M19012","W19XXXD","J9621","F32A","Z114","Z01419","M9903","M4606","M9904","M4608","H8110","B372","I63511","R079","I517","R0902","Z1159","R040","Z0110","J301","S0340XA","H04123","J320","R059","Z8719","N939","Z79890"],"date":["2024-12-16","2024-04-03","2023-01-25","2024-09-24","2024-08-09","2025-10-13","2024-11-11","2024-09-25","2025-04-23","2025-04-23","2023-09-19","2023-07-12","2024-04-02","2023-01-25","2023-04-20","2023-10-06","2023-10-06","2025-01-15","2024-06-05","2024-09-30","2024-08-09","2025-10-31","2024-08-09","2024-08-11","2023-10-06","2024-08-09","2024-08-10","2024-08-10","2024-06-05","2025-10-13","2024-10-29","2025-03-11","2023-07-27","2023-04-17","2025-03-11","2024-10-29","2024-10-29","2025-02-24","2023-04-17","2024-06-05","2025-01-15","2024-01-18","2023-09-08","2023-09-08","2023-09-08","2024-08-11","2024-08-11","2023-02-13","2025-01-15","2023-06-15","2023-06-15","2023-06-15","2023-06-15","2024-10-01","2023-11-29","2024-08-09","2023-07-27","2023-07-30","2024-08-09","2023-02-13","2022-11-08","2022-11-08","2022-11-08","2022-11-08","2022-11-01","2022-10-05","2022-10-05","2022-10-05","2022-09-21","2022-09-21"],"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":[["","","GLIPIZIDE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":""}]}]}