{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane E Clanton","gend":1,"currentgend":"","add":"91 HIGH ST APT 102","city":"BIDDEFORD","state":"ME","zip":"04005","dob":"1961-03-31","age":"","mstatus":"","insh":"10000086165","cliId":"","pno":2079290435,"cno":"","email":"Ladydianexx54@gmail.com","ename":"","eno":"","pphy":"HANDANOS, NICHOLAS G","ppno":2072823349,"pcpadd":"46 BARRA RD STE 201202,","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"40059459","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"91 HIGH ST APT 102","madd2":"","madd3":"","mcity":"BIDDEFORD","mstate":"ME","mzip":"04005","pcpfaxno":2072826099,"pcpnpi":1619914025,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6VD6G86MV56","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I83019","I83029","L97919","L97929","E11620","R1110","R2241","L03116","Z1231","I872","Z79891","R600","R55","M5416","G894","M47816","M7918","N1831","S81802A","L03119","E1122","N1830","R09A2","L03115","E1159","B351","M79674","L602","L851","M47817","M461","I83028","F3342","F17210","F411","F330","I890","I10","E782","J418","M205X9","E11621","Z01419","Z124","L0390","Z1889","I83892","R609","Z1211","F419","E11622","K5900","A000","T18128A","J449","F418","R4182","K5710","G4733","F39","R601","L98499","E6601","F3181","Z0000","R262","Z122","Z87891","E139","Z4800","E871","M7989","I739","Z79899","S91209A","R0609","R0683","I878","G4710","F17211"],"date":["2024-06-13","2024-05-02","2024-06-13","2024-05-02","2024-05-10","2024-05-04","2024-05-07","2024-03-30","2023-08-31","2024-06-13","2024-02-13","2024-03-15","2024-05-05","2024-04-09","2024-10-10","2024-04-09","2024-04-09","2024-09-17","2023-02-21","2024-01-25","2024-01-25","2024-01-25","2024-11-11","2024-04-28","2024-10-09","2024-10-09","2024-10-09","2024-10-09","2024-02-06","2023-06-05","2023-06-05","2023-03-07","2024-12-30","2024-09-26","2024-12-30","2024-02-13","2024-06-13","2023-10-31","2023-10-31","2023-10-31","2024-02-06","2024-01-31","2023-03-16","2023-03-16","2024-03-14","2024-05-02","2023-02-07","2023-01-30","2024-06-20","2024-12-30","2023-02-14","2023-10-24","2023-12-31","2024-11-11","2024-11-11","2024-11-11","2024-11-11","2024-11-11","2024-09-26","2024-06-13","2024-06-12","2022-11-28","2022-12-20","2024-07-25","2024-06-12","2023-07-31","2024-07-19","2024-07-19","2022-12-29","2024-04-29","2024-05-17","2024-01-11","2024-01-16","2024-12-30","2023-02-14","2022-11-10","2022-11-10","2022-10-14","2022-10-12","2022-10-12"],"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":[["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","PRAZOSIN HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","OXCARBAZEPINE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PROMETHAZINE HCL","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","FLUCELVAX QUAD 2023-2024","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUCELVAX QUAD 2022-2023","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PREVNAR 20","","","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":""}]}]}