{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cheryl D Clukey","gend":1,"currentgend":"","add":"20 SPRING ST","city":"Augusta","state":"ME","zip":"04330","dob":"1948-06-06","age":"","mstatus":"","insh":"10000087800","cliId":"","pno":2074410337,"cno":"","email":"cherylclukey5@yahoo.com","ename":"","eno":"","pphy":"SEYMOUR, CHERYL K","ppno":2076261561,"pcpadd":"Family Medicine Institute,15 E Chestnut St","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICINE INSTITUTE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 SPRING ST","madd2":"","madd3":"","mcity":"Augusta","mstate":"ME","mzip":"04330","pcpfaxno":2076261849,"pcpnpi":1023084233,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6RN6CE5AE62","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M542","E0590","M170","E041","Z466","Z5321","Z01810","Z0000","H9190","S81802D","X58XXXD","L309","Z7901","M25561","M1711","M25461","E042","G8929","R319","M62838","M810","Z780","Z1231","N6489","R310","Z1211","D120","K648","R928","K6389","H903","H938X2","S81802A","X58XXXA","I4891","I491","R9431","Z23","I4710","N202","L97922","F1190","I480","I428","N200","S80812A","W010XXA","M5030","M47812","R221","M9901","M9900","M9903","M9905","M25462","M25562","K7689","K769","L03116","M4721","M4722","M4802","I878","I081","I429","R5383","F32A","D509"],"date":["2023-08-29","2025-11-07","2025-10-21","2025-09-05","2024-02-22","2024-02-15","2025-11-05","2025-05-06","2023-08-29","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2025-03-27","2025-03-27","2025-03-27","2025-09-24","2023-01-03","2023-04-04","2023-01-03","2025-02-25","2025-02-25","2024-03-20","2024-03-21","2024-02-16","2024-03-15","2024-03-15","2024-03-15","2024-03-21","2024-03-15","2023-10-04","2023-10-04","2025-02-18","2025-02-12","2025-11-05","2025-11-05","2025-11-05","2025-10-03","2025-10-03","2024-01-30","2025-01-13","2023-11-10","2025-08-14","2025-08-14","2024-11-05","2024-12-16","2024-12-16","2023-11-05","2023-11-05","2023-11-05","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2025-06-13","2025-06-13","2023-12-18","2023-12-18","2025-01-13","2023-04-29","2023-04-29","2023-04-29","2024-02-15","2022-11-18","2022-11-18","2022-10-21","2022-10-21","2022-08-22"],"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":[["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","METHIMAZOLE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","XARELTO","","","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":""}]}]}