{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janice L Denicola","gend":1,"currentgend":"","add":"24 INLAND FARM RD","city":"WINDHAM","state":"ME","zip":"04062","dob":"1952-08-01","age":"","mstatus":"","insh":"10000087027","cliId":"","pno":3173194634,"cno":"","email":"janicedenicola@gmail.com","ename":"","eno":"","pphy":"JOHNSON, ELLIS A","ppno":2076621340,"pcpadd":"1 HARNOIS AVE STE 1B,","pcpcity":"WESTBROOK","pcpstate":"ME","pcpzip":"40924395","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 INLAND FARM RD","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":2076621341,"pcpnpi":1215196985,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8W50M81QJ11","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5417","M79605","M5450","R531","Z96642","G4733","R059","Z01818","E038","E063","D3612","D242","M810","F329","R030","R0683","M1612","Z1211","K635","Z860101","K5730","E349","G63","H2513","H5203","H3540","L821","Z85828","D229","R928","M25641","M79644","R600","M67441","R921","K3189","N904","Z471","Z96652","M25551","I10","Z1231","S50862A","R922","M160","C44319","Z1389","Z124","G8918","K219","D492","D1801","L570","M47817","Z23","M25741","R7989","E559","R7303","E785","Z0000","M8580","H524","F418","R4182","Z79899","M25552","I088","R0602","J069","R5383","Z1239","E8352","J209","U071","J181","R918","J040","Z87898","K2270"],"date":["2024-05-30","2024-05-30","2025-03-20","2025-03-20","2025-03-20","2025-11-17","2023-02-01","2024-07-18","2025-05-02","2024-07-15","2025-03-07","2024-02-15","2025-06-20","2025-10-10","2025-10-10","2025-10-10","2024-10-08","2025-04-16","2025-04-16","2025-04-15","2025-04-15","2024-02-01","2024-02-01","2024-12-31","2024-12-31","2024-12-31","2025-04-29","2025-04-29","2025-04-29","2024-02-15","2025-03-14","2025-03-14","2025-03-14","2025-03-14","2024-02-15","2025-04-16","2022-12-02","2024-11-05","2024-11-05","2024-02-08","2025-05-02","2025-01-10","2024-05-03","2024-01-18","2024-02-02","2023-10-05","2024-01-08","2024-01-08","2024-09-23","2025-04-16","2023-05-05","2023-05-05","2023-05-05","2025-03-04","2025-10-06","2025-01-24","2023-11-28","2023-11-28","2022-12-15","2025-05-02","2022-12-15","2025-05-02","2023-10-23","2025-04-16","2025-04-16","2025-04-25","2024-08-29","2022-08-12","2022-08-12","2022-09-02","2022-09-02","2022-09-02","2022-09-02","2022-07-18","2022-08-02","2022-07-19","2022-07-19","2022-07-13","2022-07-13","2021-12-10"],"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":[["","","TRULICITY","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","JOURNAVX","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}