{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karen L Frechette","gend":1,"currentgend":"","add":"28 MARINA RD","city":"Sebago","state":"ME","zip":"04029","dob":"1956-05-10","age":"","mstatus":"","insh":"10000085310","cliId":"","pno":2077491777,"cno":"","email":"declined@072123.com","ename":"","eno":"","pphy":"LITTLE, KASEY R","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 199","madd2":"","madd3":"","mcity":"SEBAGO","mstate":"ME","mzip":"04029","pcpfaxno":2078741483,"pcpnpi":1720441595,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4UA1DC0GE01","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I7120","I4891","I959","R509","A7749","I480","H25812","H43813","R059","Z7901","A7982","R748","Z1231","M1612","M7671","S99911A","Z0101","J069","J029","Z0001","M533","R5381","H25811","M5450","R5383","I10","M25552","I77810","M160","M25462","M159","I719","R918","R9389","A419","L570","M8580","Z0000","M25559","M25561","Z23","I712","R002","R000","Z13220","S52532D","R760","M8588","S62102A","S52502A","S52572A","W009XXA","S5292XA","S52572D","R6889","S52532A","S6292XS"],"date":["2025-04-28","2023-08-16","2023-08-16","2023-08-16","2023-08-28","2025-01-02","2024-11-12","2024-09-10","2023-08-14","2023-08-14","2023-08-16","2023-07-24","2024-06-05","2025-08-13","2024-07-09","2024-07-09","2025-04-30","2023-01-13","2023-01-17","2023-10-13","2022-12-16","2023-08-16","2024-11-26","2023-09-20","2023-09-20","2025-03-21","2025-06-23","2023-08-16","2022-12-16","2022-12-16","2023-04-13","2025-04-28","2023-08-15","2023-08-15","2023-08-16","2025-03-21","2024-12-23","2025-01-02","2022-11-09","2022-11-09","2022-09-08","2022-08-22","2022-04-29","2022-04-22","2022-04-22","2022-03-02","2021-11-12","2021-12-22","2022-01-08","2022-01-08","2022-01-10","2022-01-10","2022-01-08","2022-01-24","2021-12-27","2022-02-10","2022-02-10"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}