{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cheryl A Whitmore","gend":1,"currentgend":"","add":"28 SERENDIPITY LN","city":"HANCOCK","state":"ME","zip":"04640","dob":"1955-12-28","age":"","mstatus":"","insh":"10000092731","cliId":"","pno":2074793462,"cno":"","email":"Decline@12212023.com","ename":"","eno":"","pphy":"TAINTER, RUTH B","ppno":2076672288,"pcpadd":"Bucksport Regional Health Center,37 Commerce Park","pcpcity":"Bucksport","pcpstate":"ME","pcpzip":"04416","pcpcounty":"","pcpid":"","pcpname":"BUCKSPORT REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 SERENDIPITY LN","madd2":"","madd3":"","mcity":"HANCOCK","mstate":"ME","mzip":"04640","pcpfaxno":2076676888,"pcpnpi":1134438625,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1WW9CR8YQ28","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S31109A","A419","L02211","Z432","Z433","R011","R002","D72829","K5900","K56609","D509","I10","E039","F419","K9402","R7881","N1830","K435","K651","B9689","I2782","T8142XA","R109","K433","Z885","Z882","Z881","R112","N390","R0902","R000","N319","R5381","K632","R6510","G894","L03311","B958","Z98890","R9431","Z86711","K8020","Z0000","R0602","R7309","Z131","R0600","Z0100","Z515","J9601","G9341","I2699","R4182","R1310","N1330","J45901","J209","Z20822","Z79899","R030","Z6831","K2950","Z933","R5383","R799","L089","N898","Z09","R7981","F321","M810","I129","Z436","Z6832","T83718D","I2694","Z1231","K9400","L0291","R918","T8149XA","N2889","S3092XD","R079","R791","R0789","R110","M5442","N200","K6389","R509","K760","A414","H43813","Z13220","L988","R531","T8189XA","S31104A","J9811","J95821","M542","B372","L02416","D649","R0609","T83719A","A4150","F320","M159","K9403","Y838","Y811","Y929","Z906","M5116","M4317","K219","F32A","R1032","K439","K8689","H43812","R8290","Z936","Z6830","E669"],"date":["2023-12-06","2025-01-06","2025-08-07","2025-07-18","2025-07-18","2024-12-05","2023-12-07","2023-02-12","2023-09-29","2025-01-03","2025-09-08","2025-09-08","2025-09-08","2023-09-29","2025-01-03","2023-02-09","2024-11-21","2025-06-30","2023-02-06","2023-02-06","2023-02-06","2023-02-05","2023-02-05","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2025-01-03","2025-05-14","2024-10-31","2024-10-31","2024-11-21","2023-02-09","2025-06-30","2025-01-06","2024-01-08","2023-02-23","2023-02-23","2023-05-26","2023-09-08","2023-09-07","2025-08-29","2025-09-15","2025-05-14","2024-09-25","2024-09-25","2023-04-18","2024-11-22","2024-02-21","2023-04-17","2023-01-28","2023-01-30","2023-01-30","2022-10-20","2024-11-21","2023-04-20","2023-04-18","2023-04-18","2023-04-18","2025-01-03","2022-11-22","2022-10-20","2025-08-07","2023-02-02","2023-02-02","2025-06-30","2022-10-20","2024-11-07","2023-04-17","2024-10-13","2024-10-13","2024-10-13","2025-04-18","2023-06-27","2022-11-07","2023-01-31","2025-05-14","2025-01-08","2025-04-04","2025-01-03","2023-03-23","2024-01-18","2024-02-15","2025-05-14","2025-05-14","2025-05-14","2025-05-14","2024-07-02","2023-02-03","2023-02-03","2023-02-03","2025-08-29","2023-02-12","2023-08-09","2025-09-08","2025-01-16","2024-10-29","2024-01-11","2025-02-24","2023-01-31","2023-01-31","2024-07-26","2025-04-08","2023-02-22","2024-11-21","2024-12-05","2022-11-18","2023-02-03","2023-12-15","2023-12-15","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2024-12-13","2024-07-02","2024-07-02","2023-02-24","2023-02-24","2024-08-06","2023-07-13","2023-07-13","2023-01-10","2023-08-16","2022-08-30","2022-08-23","2022-08-09"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","DEXLANSOPRAZOLE DR","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","PROMETHAZINE HCL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","DEXILANT","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ENDOCET","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","OMEPRAZOLE","","","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":""}]}]}