{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ellen M Richardson","gend":1,"currentgend":"","add":"20 GREAT FALLS PLAZA APT 314","city":"AUBURN","state":"ME","zip":"04210","dob":"1956-02-02","age":"","mstatus":"","insh":"10000085337","cliId":"","pno":2073449085,"cno":"","email":"Miracle137@msn.com","ename":"","eno":"","pphy":"BUTTERFIELD, TAYLOR C","ppno":2077847388,"pcpadd":"Family Health Care Associates,190 Stetson Rd","pcpcity":"Auburn","pcpstate":"ME","pcpzip":"04210","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 GREAT FALLS PLAZA APT 314","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":2077952043,"pcpnpi":1427288810,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5YJ3VE7AH11","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79604","M5459","Z09","G959","K7460","C4442","E6601","D044","G4700","E1169","I10","M4316","L84","M79672","M79671","E1159","B351","M79675","M79674","M5450","M47816","M5136","Z780","E1165","L821","L814","Z01818","L570","D485","R5381","R630","R1011","D098","E113413","H43812","M4802","Z1283","Z0101","E113393","E119","Z794","R197","M5127","M47817","Z981","M65322","Z0000","E782","E1142","M4712","Z86010","Z1231","Z1211","D122","D123","M50021","M25511","B079","R296","D696","R52","R29898","M48062","C44329","S92421A","M5000","L600","R2689","M542","M65311","R109","F39"],"date":["2025-11-14","2024-05-09","2025-03-11","2025-03-11","2024-12-02","2025-10-29","2025-05-12","2025-11-03","2025-11-10","2025-11-10","2025-11-10","2024-05-28","2025-06-24","2025-06-24","2025-06-24","2025-09-09","2025-09-09","2025-09-09","2025-09-09","2024-04-02","2024-05-28","2024-05-28","2023-11-29","2025-10-28","2023-08-22","2025-09-02","2024-07-29","2025-09-02","2023-08-22","2023-05-09","2023-05-09","2023-05-09","2025-11-03","2023-08-02","2023-02-01","2024-10-10","2025-09-02","2022-12-07","2022-12-07","2024-10-02","2024-10-02","2023-05-10","2024-05-28","2024-05-28","2024-10-10","2023-07-10","2024-12-03","2025-10-28","2025-10-28","2024-10-10","2023-10-03","2022-12-07","2024-01-04","2024-01-04","2024-01-04","2024-06-15","2023-12-26","2023-08-22","2024-04-02","2023-06-09","2024-05-09","2024-04-02","2024-06-07","2025-09-02","2024-02-15","2025-10-10","2024-02-15","2024-06-10","2025-10-10","2022-10-27","2022-07-12","2022-05-03"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","AMMONIUM LACTATE","","","Select","Select",""],["","","NOVOLOG MIX 70-30 FLEXPEN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"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":""}]}]}