{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Judith M Fehr","gend":1,"currentgend":"","add":"158 DANFORTH ST APT 7","city":"Portland","state":"ME","zip":"04102","dob":"1948-01-25","age":"","mstatus":"","insh":"10000090810","cliId":"","pno":6096105570,"cno":"","email":"fehrmaggie@comcast.net","ename":"","eno":"","pphy":"LENA, SEAN R","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"158 DANFORTH ST APT 7","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04102","pcpfaxno":2078741483,"pcpnpi":1265895502,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1FF9RF6KT37","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N6312","F411","F329","N6489","G2111","F330","E785","G219","R051","Z0000","Z23","E663","Z6829","F4312","F334","N6001","K1230","L821","D1801","R4189","D225","L814","L568","F325","H401231","J0180","Z131","K146","Z1231","H43393","H43811","U071","K140","Z8719","M8588","M25561","M25562","R531","R2681","R0789","R1110","D492","H409","R079","Z961","M5450","M25552","M25551","M47896","M5459","M48061","M6289","R29898","R739","M1712","M25762","M1711","M25761","Z13228","Z130","D2239","H52223","Z1329","B349","H401130","F319","M2550","F349","G20","G4763","M542","M9900","M9901","M9902","M9903","R6889","M7910","M7062","G2119","M9906","M5136","M170","M47816"],"date":["2024-11-04","2025-10-21","2025-10-21","2024-10-14","2024-10-29","2025-11-04","2025-10-27","2024-12-10","2025-08-05","2025-08-04","2025-08-04","2025-08-05","2025-08-05","2024-08-12","2025-03-24","2024-11-04","2024-10-02","2025-10-10","2024-10-02","2025-11-08","2025-10-10","2025-10-10","2025-10-10","2024-07-23","2025-10-22","2025-02-13","2025-10-07","2025-09-16","2024-09-06","2025-04-23","2025-04-23","2024-12-01","2024-08-28","2024-08-28","2024-08-21","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2024-02-15","2024-02-15","2024-01-19","2024-05-01","2024-02-15","2024-05-07","2023-06-12","2023-06-12","2023-06-12","2023-06-12","2023-04-25","2023-04-25","2023-04-25","2023-04-25","2023-07-06","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2023-01-04","2023-01-04","2024-01-19","2024-05-01","2023-01-04","2024-02-15","2022-11-23","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-04-28","2022-07-27","2022-07-27","2022-07-13","2022-07-13","2022-07-06","2022-07-06","2022-05-04"],"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":[["","","LAMOTRIGINE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","DESVENLAFAXINE SUCCINATE ER","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISOLONE","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","PREDNISOLONE SODIUM PHOSPHATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":""}]}]}