{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Catherine K Gasper","gend":1,"currentgend":"","add":"26 OLD WINTHROP RD","city":"MANCHESTER","state":"ME","zip":"04351","dob":"1953-06-28","age":"","mstatus":"","insh":"10000086407","cliId":"","pno":2075929050,"cno":"","email":"cathy_gasper@yahoo.com","ename":"","eno":"","pphy":"STRICKLAND, DONALD J","ppno":2076238434,"pcpadd":"\tKennebec Internal Medicine,9 Glenridge Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"KENNEBEC INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"26 OLD WINTHROP RD","madd2":"","madd3":"","mcity":"MANCHESTER","mstate":"ME","mzip":"04351","pcpfaxno":2076214370,"pcpnpi":1861431819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2HE7CE2NV40","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J324","G2581","J309","K449","M62830","G629","M9905","M25551","M9903","H6092","K219","M1712","M25562","Z98890","M75101","Z713","K30","H6123","R059","M25512","J329","M810","H6120","L570","R1310","R4182","R1110","R5383","J40","Z1231","M8589","L509","Z1211","R42","L501","J4530","Z7951","H93A9","H40012","E785","Z23","H33312","H35372","H3581","H2513","K5730","K648","R002","R635","Z800","K3184","R0602","M19072","R079","R197","M7702","R739","M9902","M5124","Z96652","M9904","M25552","G609","J3089","R1010","M7701","M1711","K580","R0600","M9908","H40003","M25511","M170","M25561","R519","R0981","J029","Z1151","Z01419","R109","R300","R350","L814","D225","L821","N390","Z124","Z0000","I4710","I493","I491","R0789","J3489","R7989","R0781","L817","L720","M75111","R55","E739","H539","Z872","Z96641","J45909","Z4789","R053","K317","Z20822","E039"],"date":["2025-10-20","2025-04-25","2025-11-05","2023-04-28","2025-10-06","2025-04-25","2025-08-20","2024-12-27","2024-12-27","2024-09-01","2025-05-14","2025-11-06","2025-01-27","2023-06-30","2022-12-13","2024-08-15","2023-05-17","2025-06-12","2023-01-11","2025-05-14","2025-07-17","2025-07-17","2023-12-18","2024-03-11","2023-04-28","2023-04-28","2023-04-28","2024-12-31","2022-12-29","2023-09-14","2023-09-14","2025-11-04","2023-02-10","2023-08-10","2025-10-14","2023-09-27","2023-09-27","2025-04-18","2025-03-14","2024-12-31","2025-10-30","2023-12-14","2023-12-14","2023-12-14","2023-12-14","2023-02-10","2023-02-10","2023-12-11","2023-12-11","2023-02-10","2023-04-28","2023-07-12","2025-09-02","2025-09-02","2024-06-25","2024-01-04","2024-12-31","2025-10-06","2025-10-06","2025-01-27","2024-06-03","2025-08-20","2024-12-31","2025-10-28","2023-05-31","2023-11-27","2023-02-07","2024-06-25","2023-07-04","2024-12-04","2022-12-27","2023-03-30","2023-03-30","2023-03-30","2022-12-19","2022-12-19","2022-12-19","2023-06-15","2023-06-15","2023-06-19","2023-06-19","2023-06-19","2025-01-29","2025-01-29","2025-01-29","2023-06-19","2023-06-15","2024-12-19","2023-10-05","2023-10-05","2023-10-05","2025-08-28","2025-10-20","2023-07-04","2023-07-04","2023-01-12","2024-01-18","2023-06-30","2023-09-07","2024-04-08","2024-03-13","2024-03-11","2024-03-11","2023-07-12","2022-11-09","2022-10-14","2022-10-14","2022-10-20","2022-10-14"],"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":[["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA ER","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","RIZATRIPTAN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PROLIA","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","BUDESONIDE","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","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":""}]}]}