{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Virginia L Nickerson","gend":1,"currentgend":"","add":"7 MACKWORTH LN","city":"CUMBERLAND FORESIDE","state":"ME","zip":"04110","dob":"1933-05-20","age":"","mstatus":"","insh":"10000094379","cliId":"","pno":3394400110,"cno":2077475302,"email":"Ginnick7@gmail.com","ename":"","eno":"","pphy":"PIERCE, DANIEL C","ppno":2078469013,"pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 MACKWORTH LN","madd2":"","madd3":"","mcity":"CUMBERLAND FORESIDE","mstate":"ME","mzip":"04110","pcpfaxno":2078741483,"pcpnpi":1861451080,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9QF9VH5QP14","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I080","I5020","I499","E8352","A0472","I5042","U071","I480","Z23","Z950","I420","S32131A","I340","B351","I8003","M79674","M79675","I213","S32131D","H903","R197","S0101XA","S51002A","R0789","S81802A","I7389","R102","Z136","M25512","Z471","Z96612","S0180XD","Z4802","Z043","G319","R9089","M1612","M25552","N184","M79641","M1811","S0003XA","Z7901","R570","M069","Z79899","H538","M25511","E039","M25551","M160","S7002XA","R296","S0100XA","S0181XA","N1832","R051","S0083XA","M25571","I872","R7989","D7589","H5000","H532","L309","Z0001","M7989","R079","I130","Z515","Z7189","R262","H9313","R4182","R2242","M25471","D649","L03115","R0600","R2681","R2689","Z0000","M810","S060X0A","M542","I4891","I429","S299XXA","S3991XA","S3993XA","S199XXA","S0990XA","R21","M79602","R54","D696","R58","W1849XA","I083","M19071","I4821","A0471","M25462","J811","J90","I517","Z96652","I700","A6920","K529","M25522","S4991XD","S41119A","Z96611","M25521","G9389","R404","R6884","R490","S59901A","M79601","W19XXXA","S5012XA","R0602","M25562","L03119","S7001XA","S40011A","S51011A","L0390","M79604","M79606","T148XXA","I10","S90111A","K6289","L02416","L03116","S41112D","R109","K6389","I509","E871","E869","I5023","F0394","M2042","M7742","M79662","S8012XA","A000","Z961","I129","N189","F411","S81802D","R42","H52223","S8992XA","I088","I501","R931","R6889","D2372","M71572","L603","L723","Z85828","L84","C44320"],"date":["2024-01-23","2025-10-05","2025-10-05","2024-09-05","2022-12-05","2025-06-04","2022-12-05","2024-05-15","2024-10-30","2025-09-03","2025-05-27","2023-01-05","2023-12-21","2025-09-30","2025-09-30","2025-09-30","2025-09-30","2025-10-06","2023-03-08","2024-01-03","2024-12-06","2025-07-26","2024-03-27","2024-03-27","2024-03-27","2024-05-01","2025-03-10","2025-06-04","2025-03-10","2025-03-10","2025-03-10","2024-04-01","2024-04-01","2025-03-10","2025-03-10","2025-04-11","2025-03-14","2025-03-14","2025-08-26","2025-04-11","2025-04-11","2025-07-26","2025-05-29","2025-10-05","2025-07-09","2025-01-08","2025-01-08","2024-01-01","2025-03-03","2025-04-11","2025-04-11","2025-03-10","2025-08-05","2025-08-05","2024-03-23","2024-01-16","2025-01-29","2025-04-11","2025-07-09","2025-07-09","2024-05-22","2024-05-22","2023-10-24","2023-11-13","2025-08-26","2023-07-24","2025-05-27","2025-10-05","2025-05-27","2025-10-05","2025-10-05","2023-06-12","2022-12-22","2025-10-05","2025-01-30","2025-05-29","2025-05-29","2025-05-27","2022-12-09","2024-05-03","2024-05-03","2024-07-25","2024-04-01","2023-01-05","2023-01-05","2023-08-03","2023-01-02","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2025-07-26","2024-07-01","2024-03-23","2023-01-06","2024-01-16","2025-07-26","2025-07-26","2025-10-05","2025-05-27","2024-11-08","2025-04-10","2023-08-03","2023-12-10","2023-12-10","2023-12-10","2023-08-03","2025-10-05","2024-06-29","2024-07-26","2024-03-23","2023-08-29","2023-08-29","2023-08-27","2023-08-27","2024-03-23","2024-03-23","2024-02-26","2024-02-26","2023-08-27","2023-08-27","2023-08-27","2024-04-07","2023-12-05","2023-08-03","2023-02-01","2023-08-28","2023-08-28","2023-08-28","2023-02-15","2023-02-15","2023-08-03","2023-02-02","2023-02-02","2024-09-04","2023-02-10","2022-11-20","2022-11-20","2022-11-20","2022-10-31","2022-10-31","2022-10-31","2022-11-21","2022-11-07","2022-11-09","2022-11-09","2022-10-04","2022-10-04","2022-10-09","2022-10-09","2022-10-12","2022-10-21","2022-10-11","2022-10-11","2022-10-05","2022-09-14","2022-08-09","2022-08-24","2022-08-13","2022-08-01","2022-08-01","2022-08-01","2022-07-06","2022-03-15","2022-03-15","2022-03-15","2022-03-25","2022-03-25","2022-02-03","2022-02-03"],"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":[["","","TORSEMIDE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","VANCOMYCIN HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DIFICID","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","PROLIA","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}