{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Helen T Melanson","gend":1,"currentgend":"","add":"456 SNOW HILL RD","city":"NEW GLOUCESTER","state":"ME","zip":"04260","dob":"1956-12-13","age":"","mstatus":"","insh":"10000092546","cliId":"","pno":2075763425,"cno":"","email":"hmelanson10@gmail.com","ename":"","eno":"","pphy":"BERGERON, AMY L","ppno":2077955750,"pcpadd":"Central Maine Family Medicine,12 High St Ste 302","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"GRAY FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"456 SNOW HILL RD","madd2":"","madd3":"","mcity":"NEW GLOUCESTER","mstate":"ME","mzip":"04260","pcpfaxno":"","pcpnpi":1417944455,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6RG3QK3YX82","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M65321","Z1231","F4321","F419","F32A","H25811","F17210","H16223","F17200","E785","Z87891","S86112A","H11121","H25812","M79672","M5430","E669","Z122","M47816","J40","M7989","Z98890","M25649","M5431","J449","M5136","Z1211","D120","D122","D123","M5442","U071","H52222","H2181","J440","N390","J441","Z0000","M109","I10","H26493","M5116","M4726","G479","J302","Z4889","E876","M5450","X58XXXA","Z0389","H43313","Z86010","K5730","H43811","H43812"],"date":["2024-10-04","2024-12-03","2024-09-13","2025-08-18","2024-09-13","2023-02-01","2024-12-12","2025-04-15","2025-08-18","2024-09-09","2024-12-28","2023-05-18","2023-05-23","2023-02-08","2024-12-08","2024-07-09","2024-11-29","2023-11-04","2024-06-23","2025-08-18","2023-12-05","2023-12-05","2024-12-06","2024-05-05","2025-08-18","2024-05-11","2024-01-15","2024-01-15","2024-01-15","2024-01-15","2023-05-15","2023-03-21","2023-02-08","2023-02-08","2022-12-15","2022-12-15","2022-12-15","2024-08-30","2023-08-28","2023-08-21","2025-04-15","2024-06-23","2024-06-23","2024-02-19","2024-03-12","2023-10-30","2025-02-24","2024-06-14","2023-05-18","2023-05-18","2022-09-16","2022-09-30","2022-09-30","2022-09-01","2022-09-01"],"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":[["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUZONE QUAD 2023-2024","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","CYCLOSPORINE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FLUTICASONE-VILANTEROL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","CEQUA","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","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":""}]}]}