{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Debra A Dahms","gend":1,"currentgend":"","add":"6 REBA LN","city":"WINDHAM","state":"ME","zip":"04062","dob":"1951-12-01","age":"","mstatus":"","insh":"10000093051","cliId":"","pno":2073108700,"cno":"","email":"debidahms@gmail.com","ename":"","eno":"","pphy":"LAVALLEE, HEATHER A","ppno":2078930290,"pcpadd":"100 FODEN ROAD,WEST BUILDING SUITE 103","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062351","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"6 REBA LN","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":2078280188,"pcpnpi":1841569720,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4A43HE0YY82","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G243","R519","Z09","Z7409","R42","M75101","Z471","Z96611","G8929","M542","H903","H8111","S060X0S","R2681","M75121","R6889","M5481","Z981","S4991XA","G5601","M65331","M19011","K219","E785","F4310","F331","G8918","J323","H905","H9313","L570","D225","L578","L821","Z01812","M25511","F1290","M25711","M65341","I10","E6601","R0789","G4452","M25611","Z4789","E782","R4182","M720","R201","D485","L538","R197","Z0000","Z01810","R0781","R2689","S46011A","W19XXXA","R296","M25641","Z01818","G248","M47812","M4802","M5021","M5412","M2578","G959","M79601","M79602","M4722","M50121","M4723","M5011","R202"],"date":["2025-09-09","2023-10-04","2025-01-30","2023-10-31","2025-11-17","2024-07-25","2025-10-29","2025-09-30","2023-01-09","2023-04-14","2024-12-09","2025-08-05","2025-08-19","2025-11-17","2025-09-17","2023-12-29","2023-01-04","2023-05-22","2024-06-26","2025-02-11","2025-03-21","2025-09-17","2025-03-21","2025-09-17","2024-04-24","2025-10-21","2025-09-17","2024-04-08","2024-04-08","2024-04-08","2025-11-11","2025-08-27","2025-08-27","2025-08-27","2024-09-26","2025-11-13","2025-08-21","2024-08-20","2025-03-21","2025-06-02","2024-06-04","2024-08-21","2023-10-04","2024-07-10","2024-12-05","2024-10-11","2024-10-11","2025-03-21","2025-02-11","2025-07-03","2025-07-03","2025-07-24","2024-12-02","2025-09-05","2024-08-21","2023-02-08","2024-07-23","2024-07-23","2024-05-28","2023-05-22","2025-09-05","2025-09-09","2023-03-06","2023-03-06","2023-03-06","2022-09-16","2022-09-16","2022-09-16","2022-09-01","2022-09-01","2022-09-01","2022-08-16","2022-08-16","2022-08-16","2022-08-16"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","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":[]}},{"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":""}]}]}