{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary H Dalheim","gend":1,"currentgend":"","add":"24 Prospect St Apt 1","city":"Topsham","state":"ME","zip":"04086","dob":"1956-09-05","age":"","mstatus":"","insh":"10000089072","cliId":"","pno":2074586100,"cno":"","email":"xebec9556@gmail.com","ename":"","eno":"","pphy":"Watson, Ross M","ppno":"","pcpadd":"Central Maine Medical Center,4 Horton Place Ste 101","pcpcity":"Topsham","pcpstate":"ME","pcpzip":"04086","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 Prospect St Apt 1","madd2":"","madd3":"","mcity":"Topsham","mstate":"ME","mzip":"04086","pcpfaxno":"","pcpnpi":1639699051,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1UK3FD3QC88","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I5030","I639","M79603","G319","R29898","J323","M75111","Z4789","M25511","R29818","R413","S2341XA","W010XXA","R200","B351","F319","K219","N281","G4733","W19XXXA","G459","F3178","R682","M6281","H538","M75101","R079","R0789","L309","R9089","G4730","R29810","R21","L710","M7541","S46011A","M24111","E785","Z0000","R4189","S4991XA","W08XXXA","G939","R262","M79641","R7303","Q6102","M180","M75121","R4182","G8918","Z1231","L603","R9082","G35","U071","R891","Z8673","R531","M79674","M79675","R6889","H539","J329","Z713","M159","R52","R0602","J4520","M7581","Z01818"],"date":["2024-04-17","2024-04-17","2024-07-02","2024-07-02","2024-07-02","2024-07-02","2024-12-23","2025-07-08","2025-07-08","2024-07-02","2024-03-25","2023-10-30","2023-10-30","2025-05-05","2024-07-08","2025-05-05","2025-01-03","2025-05-05","2025-06-19","2024-10-28","2024-05-17","2025-04-28","2022-09-07","2024-07-02","2024-07-02","2024-12-12","2024-07-02","2024-07-03","2023-04-24","2024-04-17","2024-03-25","2024-04-17","2023-12-12","2024-09-16","2025-01-03","2025-01-03","2025-01-03","2024-11-11","2024-11-11","2024-02-20","2024-10-01","2024-10-01","2022-11-16","2024-03-04","2023-03-28","2023-11-10","2025-03-14","2023-08-04","2025-01-03","2025-01-03","2025-01-03","2024-01-08","2024-01-08","2022-11-16","2022-11-16","2023-05-25","2024-10-17","2024-10-17","2024-04-17","2024-07-08","2024-07-08","2023-02-20","2024-04-17","2024-04-17","2024-12-26","2024-11-14","2023-12-14","2024-07-02","2023-11-10","2024-11-26","2024-11-26"],"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":[["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","IVERMECTIN","","","Select","Select",""],["","","PIMECROLIMUS","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","DICLOFENAC POTASSIUM","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ZALEPLON","","","Select","Select",""],["","","MUPIROCIN","","","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":""}]}]}