{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah A Mullis","gend":1,"currentgend":"","add":"72 MITCHELL HILL RD","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1955-11-13","age":"","mstatus":"","insh":"10000091956","cliId":"","pno":2072105966,"cno":"","email":"","ename":"","eno":"","pphy":"DEKKER, KIMBERLY L","ppno":2073303950,"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":"72 MITCHELL HILL RD","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":2073303955,"pcpnpi":1205190220,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5AW7UX7DM35","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25551","H259","Z0000","M25571","M25671","S82851D","Z4789","M8588","T8131XA","M86171","S82851A","E063","S92025A","Z9851","Z23","Z0101","R1031","K5730","L041","S82852A","M93271","E039","I10","H2511","T8131XD","M9902","M1611","W109XXA","Z87891","M9901","M9908","M9903","M659","X58XXXA","M9906","S99912A","Z7901","H2513","H52223","Z472","T8579XA","M869","M898X6","Z969","S82851S","Z1231","H1045","H0289"],"date":["2024-08-29","2023-05-24","2025-06-17","2024-10-29","2024-10-29","2024-10-29","2024-05-24","2023-10-30","2023-10-18","2024-01-05","2023-10-18","2025-06-17","2023-08-27","2023-08-27","2024-05-21","2024-01-30","2024-09-03","2024-09-03","2024-08-30","2023-09-07","2023-09-07","2023-12-20","2025-06-17","2023-05-24","2023-11-06","2024-12-26","2024-08-29","2023-08-31","2023-12-20","2024-12-26","2024-12-26","2024-12-26","2024-05-24","2023-09-07","2024-06-11","2023-08-27","2023-10-18","2023-01-27","2023-01-27","2023-12-20","2023-12-20","2023-12-20","2023-10-18","2023-12-20","2023-12-20","2024-05-24","2022-05-31","2022-04-16"],"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":[["","","ATENOLOL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","LINEZOLID","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","OXYCODONE HCL","","","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":""}]}]}