{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth A Herring","gend":1,"currentgend":"","add":"300 EAST BRIDGE ST 319","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1950-02-17","age":"","mstatus":"","insh":"10000092575","cliId":"","pno":2076152593,"cno":"","email":"","ename":"","eno":"","pphy":"MURRAY PULSIFER, KRISTY A","ppno":2078741489,"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":"300 EAST BRIDGE ST. 319","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":2078741483,"pcpnpi":1356310098,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8T90TK2WP00","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0609","R0602","R634","E041","R300","R350","E1165","R0600","F32A","E1169","Z794","H35372","R1013","R112","R197","S42402A","Z0001","Z1231","E785","Z23","N390","R5383","E1159","S42492D","S42402D","I5189","E042","S022XXA","S0990XA","S199XXA","Z0000","R930","N289","H33011","N1831","S42452D","S42462D","H43812","R42","E559","N281","R1110","I10","Z87891","S4992XA","R519","R410","R079","R058","Z8709","S52592D","R110","F419","R1084","K861","R739","S52502D","F0781","R269","H519","R0789","R2689","R0781","R109","S52572A","I2510","I700","F331","H3589","H33021","M4802","R4189","R296","R270","H33009","H33041","Z98890","H3321","E119","Z6829","H44751","Z1889","H43813","J0190","R7982","Z1329"],"date":["2025-04-16","2025-10-14","2025-08-08","2025-10-16","2023-05-10","2024-10-28","2025-01-22","2023-12-21","2023-12-22","2024-12-02","2023-12-22","2025-08-14","2024-10-23","2024-10-23","2023-03-02","2024-11-27","2024-10-28","2023-03-13","2024-10-28","2025-09-17","2023-05-03","2023-05-03","2025-04-16","2025-04-17","2025-04-17","2024-01-22","2025-10-16","2025-02-05","2025-02-05","2025-02-05","2023-03-11","2024-07-07","2023-05-12","2025-02-04","2025-01-22","2024-07-22","2024-07-22","2025-01-30","2025-03-25","2025-04-16","2023-05-12","2023-03-02","2024-10-28","2024-10-23","2024-06-26","2024-07-07","2024-07-07","2023-05-01","2023-05-01","2023-05-01","2024-12-02","2023-12-03","2023-12-03","2024-10-23","2023-12-11","2024-10-23","2024-11-25","2025-10-08","2025-10-08","2025-10-08","2023-06-30","2023-06-30","2023-12-04","2023-12-04","2024-12-02","2025-10-23","2025-10-23","2025-10-14","2023-02-10","2023-02-17","2025-10-08","2024-11-10","2024-11-10","2024-11-10","2022-08-24","2022-08-24","2022-08-16","2022-06-08","2022-04-22","2022-03-11","2022-01-26","2022-01-26","2022-01-25","2022-02-23","2022-02-23","2022-02-14"],"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":[["","","MOUNJARO","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","DUREZOL","","","Select","Select",""],["","","BRINZOLAMIDE","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","SIMBRINZA","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","TRAVOPROST","","","Select","Select",""],["","","OCUFLOX","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}