{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ruberta S Plummer","gend":1,"currentgend":"","add":"1241 MAIN ST","city":"HARRINGTON","state":"ME","zip":"04643","dob":"1952-12-26","age":"","mstatus":"","insh":"10000086432","cliId":"","pno":2075987112,"cno":"","email":"declined@080522.com","ename":"","eno":"","pphy":"BARBEE, KRISTEN","ppno":2075462391,"pcpadd":"ONE MEDICAL CENTER DRIVE,","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"04005","pcpcounty":"","pcpid":"","pcpname":"MILBRIDGE MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 301","madd2":"","madd3":"","mcity":"HARRINGTON","mstate":"ME","mzip":"04643","pcpfaxno":2072846291,"pcpnpi":1215166533,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1TC6W85JQ62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B078","N3000","Z4502","B351","R339","I2510","I110","I5020","I255","R413","R4189","Z95810","Z818","I10","G8929","R300","E119","R399","R42","E785","M1710","R4182","N390","E8342","N3941","N3281","R351","G3184","N3020","M2010","I739","E1140","S90821D","M79672","M79671","L602","J111","R531","U071","Z0000","J209","R32","K219","K319","Z1211","B3731","R928","A419","D128","K6389","K5730","Z86010","K621","Z0100","H43823","Z122","J449","R0789","Z1231","K760","I5023","J811","R2681","G629","I509","D509","D489","M2041","I480","K2970","A4151","I4891","S90821A","Z780","M8589","R410","N189","M25562","M1712","M5450","R112","S60529A","Z87891","D72829","I081","Z0189","Z0001","R8281","D649","M6281","Z713","L0889","Z09","I429","I350","R002","Z23","B079","Z950","I459","E1342","G4733","R0981","I4819","I440","Z7982","E041","R609","I499","I447","I088","I4581","Z8679","I5022","Z6841","E1136","R6889","Z79899","E6601","S90512A","E0590","E049"],"date":["2023-01-26","2024-06-11","2025-10-30","2025-09-12","2025-07-28","2025-10-27","2025-07-18","2023-03-07","2024-03-01","2025-04-16","2024-08-06","2024-08-06","2024-08-06","2024-09-24","2024-06-21","2024-10-23","2025-11-02","2025-04-04","2025-06-20","2024-03-08","2023-10-12","2023-11-20","2025-07-28","2024-11-01","2024-06-04","2024-06-04","2024-06-04","2025-04-16","2024-06-11","2025-09-12","2025-09-12","2025-09-12","2025-01-16","2025-07-07","2025-07-07","2025-07-07","2023-11-22","2023-11-22","2023-11-22","2024-11-04","2025-09-15","2025-05-30","2024-05-01","2024-05-01","2023-03-24","2025-07-28","2024-05-06","2023-11-22","2023-03-23","2023-03-23","2023-03-23","2023-03-24","2023-03-24","2025-02-07","2023-12-22","2025-01-10","2025-10-10","2024-04-15","2025-05-20","2024-05-29","2024-01-16","2024-01-16","2024-01-16","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-11-13","2024-03-01","2024-04-12","2023-11-22","2025-08-25","2025-01-02","2025-05-20","2025-05-20","2024-09-06","2023-04-25","2023-11-15","2023-11-15","2025-07-19","2025-07-19","2024-01-08","2025-01-10","2024-03-14","2024-04-15","2024-03-14","2022-10-25","2022-10-25","2022-10-25","2022-10-31","2022-11-01","2022-10-10","2022-09-12","2022-09-30","2022-09-30","2022-09-14","2022-09-21","2022-09-21","2022-08-30","2022-08-30","2022-08-30","2022-08-24","2022-08-24","2022-07-26","2022-07-26","2022-07-26","2022-07-09","2022-06-30","2022-05-26","2022-05-26","2022-05-26","2022-05-26","2022-05-26","2022-05-12","2022-05-12","2022-05-12","2022-05-02","2022-04-22","2022-04-21","2022-04-11","2022-04-06","2022-04-06"],"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",""],["","","NOVOLIN R","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","METHIMAZOLE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","DIGOXIN","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","LANTUS","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","INSULIN GLARGINE-YFGN","","","Select","Select",""],["","","LEVEMIR","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","DOFETILIDE","","","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":""}]}]}