{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sherry L Sargent","gend":1,"currentgend":"","add":"108 BRIARWOOD RD","city":"South Portland","state":"ME","zip":"04106","dob":"1956-07-31","age":"","mstatus":"","insh":"10000088013","cliId":"","pno":2076327668,"cno":"","email":"ssargen2@maine.rr.com","ename":"","eno":"","pphy":"LIBBY, EMILY L","ppno":2078741489,"pcpadd":"InterMed,100 Foden Rd Ste 203","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"108 BRIARWOOD RD","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":2075238590,"pcpnpi":1992168710,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3KD3KV8HP82","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D801","C73","M797","G8929","Z720","Z79891","J432","Z0101","H0288B","G453","N6012","N6489","E890","E538","N289","Z0000","Z1211","D122","K621","H61031","R208","L538","Z789","K7689","K6389","Z1231","K1379","E7800","N1831","M8580","R7303","H61001","R053","R9389","R29818","I77810","R1084","N281","J441","S01301A","R221","J029","R779","Z85850","N6325","R928","R202","G43109","R251","R194","R339","D3502","L821","K5900","K429","E279","R300","R350","L578","D229","L814","D485","D128","E039","H547","G43B0","G9389","G629","M792","R41840","B370","F4322","C770","J449","F17210","C771","E041","E785","R918","R5382","M549","E876","E042","C801","M5450","M47816","C773","R739","Z905","M5127","N6011","N6315","R6889","F324","Z23"],"date":["2023-09-27","2025-11-14","2024-12-09","2023-09-27","2025-11-14","2023-09-27","2025-08-19","2025-06-17","2023-07-26","2023-07-26","2024-04-22","2024-04-22","2025-11-14","2025-10-03","2024-08-29","2025-09-23","2025-05-01","2025-05-01","2025-05-01","2024-04-22","2024-04-22","2024-04-22","2024-04-22","2024-05-10","2024-05-10","2023-04-07","2023-08-23","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2024-01-15","2024-01-15","2025-08-19","2023-09-29","2023-09-29","2024-05-10","2025-10-03","2023-12-29","2023-12-29","2025-10-17","2023-08-07","2024-05-08","2025-10-17","2023-04-07","2023-04-07","2023-07-25","2023-09-15","2024-10-14","2024-10-14","2024-10-14","2025-10-03","2023-08-28","2024-07-01","2024-07-01","2024-07-01","2025-10-30","2024-11-20","2023-08-28","2023-08-28","2023-08-28","2024-03-11","2025-05-01","2025-05-01","2023-09-08","2023-09-08","2023-09-08","2024-12-09","2024-12-09","2024-12-09","2023-08-07","2022-10-20","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-08-19","2022-08-19","2022-08-11","2022-07-01","2022-06-07","2022-06-07","2022-06-09","2022-06-09","2022-06-07","2022-05-27","2022-05-27","2022-05-18","2022-03-14","2022-03-14","2021-12-01","2021-11-15","2022-01-27"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","LORAZEPAM","","","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":""}]}]}