{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kim E Waterhouse","gend":1,"currentgend":"","add":"10 COUNTRY LN","city":"Pittston","state":"ME","zip":"04345","dob":"1956-12-23","age":"","mstatus":"","insh":"10000091659","cliId":"","pno":2072428304,"cno":"","email":"foralslice@roadrunner.com","ename":"","eno":"","pphy":"GREENLEAF, REBECCA","ppno":2077952800,"pcpadd":"76 HIGH ST FL 1,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 COUNTRY LN","madd2":"","madd3":"","mcity":"Pittston","mstate":"ME","mzip":"04345","pcpfaxno":2077952808,"pcpnpi":1164782819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1MG2UD6NE17","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z4789","R7302","J45909","I10","M722","D3613","M79671","K7581","G5601","M1811","M25552","M2011","M2012","Z471","K7460","R3915","R52","K760","G4733","Z1231","R399","K7689","J0190","Z780","Z9989","Z0101","Z1211","M19042","G5602","R300","G4730","K449","K317","G5762","M2042","M2041","H04123","G5782","K219","E785","E039","Z23","L84","M2032","F32A","K5730","M189","R350","Z800","R12","R6889","R7989","Z136","Z9049","H524","R921","M79672","R922"],"date":["2024-11-12","2025-09-05","2025-07-15","2025-03-12","2024-04-11","2023-08-31","2023-08-31","2025-08-19","2023-06-23","2023-10-24","2025-02-04","2023-09-25","2023-09-25","2024-08-05","2024-12-03","2023-10-20","2024-12-13","2024-08-29","2025-10-03","2024-11-06","2024-04-30","2022-11-30","2023-06-05","2023-11-03","2024-04-23","2025-05-09","2023-03-08","2024-05-16","2024-05-31","2024-01-27","2025-09-05","2024-05-08","2024-05-08","2023-03-06","2024-03-18","2024-03-18","2025-05-09","2023-02-22","2025-03-12","2023-05-08","2023-05-08","2023-05-08","2023-01-27","2023-01-27","2025-03-12","2023-03-08","2024-05-31","2023-07-10","2023-03-08","2023-03-08","2023-03-18","2025-08-19","2024-05-31","2023-03-20","2023-03-01","2022-11-02","2022-11-04","2022-11-02"],"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":[["","","FAMOTIDINE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMLODIPINE-OLMESARTAN","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TWINRIX","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","OLMESARTAN MEDOXOMIL","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}