{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane L Cariello","gend":1,"currentgend":"","add":"19 BLISS WOODS WAY","city":"SOUTH FREEPORT","state":"ME","zip":"04078","dob":"1955-08-28","age":"","mstatus":"","insh":"10000088231","cliId":"","pno":2073330536,"cno":"","email":"jcariello@comcast.net","ename":"","eno":"","pphy":"FUCHS ERTMAN, DEBRA","ppno":2077745816,"pcpadd":"100 GANNETT DRIVE,SUITE C","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":"PO BOX 776","madd2":"","madd3":"","mcity":"SOUTH FREEPORT","mstate":"ME","mzip":"04078","pcpfaxno":2078741483,"pcpnpi":1730158403,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7E21C40NV37","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H903","R000","F4323","F064","F3341","F411","R634","E663","Z23","R42","H8103","L570","H43812","H26493","R221","R6889","Z7184","R002","R079","I10","L661","B351","R7303","R5383","R768","H8102","R7989","K219","H2512","E538","E039","H2511","R599","Z1231","H8109","Z961","R7309","H52221","R760","E7800","Z800","J45909","H259","L659","L720","H538","H9313","Z79899","D485","E876","K5730","K449","Z0000","R933","K743","Z0001","L821","D225","D1801","L814","K760","K769","Z1211","D489","H2513","H5203","R9082","M65311","M19041","M1811","M8580","M25512","R195","H6123","I781","D229","K824","R7401","Z98890","Z0101","H02833","H02836","R110","R21","M8588","L439","L819","H9190","H8309"],"date":["2024-07-09","2024-09-12","2024-07-10","2023-10-25","2023-04-14","2024-07-25","2023-04-14","2023-04-14","2024-10-02","2024-03-12","2024-05-14","2024-03-21","2024-08-12","2024-02-06","2024-02-11","2023-02-15","2023-04-11","2024-09-03","2024-09-03","2024-12-23","2024-09-19","2024-09-19","2024-04-02","2023-04-20","2023-04-20","2024-05-22","2024-09-03","2024-07-25","2023-01-10","2023-06-06","2024-04-02","2023-01-24","2023-12-05","2024-11-14","2024-07-25","2023-04-12","2024-08-12","2024-08-12","2023-02-21","2024-04-02","2023-06-21","2023-06-21","2023-01-24","2023-08-31","2023-10-17","2023-08-15","2023-03-16","2023-07-12","2023-03-17","2023-01-03","2023-06-21","2023-06-21","2023-10-26","2022-12-16","2022-12-19","2024-04-02","2023-11-08","2023-11-08","2023-11-08","2023-11-08","2022-12-21","2022-12-21","2023-06-21","2023-10-17","2022-10-19","2022-10-19","2022-10-20","2022-09-12","2022-09-12","2022-09-12","2022-09-16","2022-09-23","2022-06-25","2022-07-05","2022-05-17","2022-05-17","2022-04-27","2022-04-27","2022-04-14","2022-04-15","2022-04-15","2022-04-15","2022-03-28","2022-03-31","2022-04-01","2022-03-31","2022-03-07","2021-12-01","2022-02-02"],"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":[["","","MOXIFLOXACIN","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","MINOCYCLINE HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","ATOVAQUONE-PROGUANIL HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","ATENOLOL","","","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":""}]}]}