{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rosemarie A Chase","gend":1,"currentgend":"","add":"3721 W RIVER RD","city":"SIDNEY","state":"ME","zip":"04330","dob":"1956-07-13","age":"","mstatus":"","insh":"10000087230","cliId":"","pno":2074625617,"cno":"","email":"chase0388@yahoo.com","ename":"","eno":"","pphy":"HALL, LAUREN","ppno":2076267400,"pcpadd":"MaineGeneral Medical Center,6 E Chestnut St","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH GERIATRIC MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3721 W RIVER RD","madd2":"","madd3":"","mcity":"SIDNEY","mstate":"ME","mzip":"04330","pcpfaxno":2076267401,"pcpnpi":1225444995,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2QW6J16PD50","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z950","I420","R002","U071","R58","R319","Z87891","Q2112","I459","M797","N762","Z0100","B309","M6208","B880","H01021","H01024","R350","R0981","R0982","R059","H02055","J0190","I480","I471","I071","J069","I10","H00024","E039","Z8673","D485","Z23","E7849","K200","I4710","I253","Z0001","J40","J22","Z1231","M85859","H43813","H25093","H5213","H52203","H524","I4430","R0609","R3915","I499","E785","Z1152","H18513","L989","Z95811","R0600","Z0000","R6889","Z13820","F419","Z8616","R399","Z136","Z0101","M4802","M5011","M50121","M4722","G459","M50322","H00011","S0992XA","W25XXXA","Q211","I700"],"date":["2025-10-08","2025-09-26","2023-01-18","2024-12-01","2024-12-01","2024-12-01","2025-05-27","2025-09-02","2023-01-12","2023-01-12","2024-11-15","2025-10-28","2024-01-10","2024-08-06","2025-01-02","2025-01-02","2025-01-02","2023-10-16","2023-10-16","2023-10-16","2023-10-16","2024-01-02","2023-11-14","2023-02-24","2023-02-24","2024-07-29","2025-03-05","2024-07-25","2024-06-11","2025-06-13","2024-07-25","2025-05-20","2023-12-27","2024-05-10","2025-02-14","2025-04-03","2025-09-02","2023-10-24","2025-03-23","2023-10-24","2024-05-07","2024-02-16","2023-11-16","2023-11-16","2023-11-16","2023-11-16","2023-11-16","2025-11-07","2025-04-03","2024-11-15","2024-01-23","2023-04-13","2025-03-05","2025-07-23","2025-05-27","2023-03-28","2025-03-05","2025-10-02","2023-07-06","2024-02-16","2023-04-27","2023-04-25","2023-04-25","2023-10-17","2024-10-25","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2022-09-12","2022-08-22","2022-08-22","2022-08-25","2022-08-25"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","XDEMVY","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","TOBRADEX","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ACYCLOVIR","","","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":""}]}]}