{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gabriele Little","gend":1,"currentgend":"","add":"18 MANOR CIR APT 5","city":"SANFORD","state":"ME","zip":"04073","dob":"1962-02-07","age":"","mstatus":"","insh":"10000094804","cliId":"","pno":2072064862,"cno":"","email":"","ename":"","eno":"","pphy":"IFANTIDES, MELISSA M","ppno":2074907998,"pcpadd":"1 MEDICAL CENTER DR,","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"40059422","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 MANOR CIR APT 5","madd2":"","madd3":"","mcity":"SANFORD","mstate":"ME","mzip":"04073","pcpfaxno":2074907999,"pcpnpi":1407992175,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3D43A58KC84","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K649","G4730","K219","R569","Z13220","M180","N644","R200","R202","S199XXA","S0990XA","S299XXA","S3991XA","S3993XA","S79922A","K648","M5416","G894","M797","G4700","F32A","M47817","G40009","G4485","M79641","N281","Z130","G5603","M79642","M25532","M5450","G8911","G8929","K644","M47818","M5136","Z79891","M47816","M461","S3992XA","Z98890","E6601","Z23","R519","E1140","K5730","F419","Z87891","Z0000","Z9181","R55","R10A1","M4726","S065X0A","G5602","R4182","R300","Z79899","Z0100","M5117","M4727","G40909","F4310","F330"],"date":["2023-04-05","2025-08-20","2025-08-20","2023-04-05","2024-02-23","2025-05-13","2025-05-15","2025-07-02","2025-07-02","2023-05-21","2023-05-21","2023-05-21","2023-05-21","2023-05-21","2023-05-21","2023-04-05","2023-08-23","2023-10-17","2025-03-05","2023-08-23","2023-07-06","2023-03-16","2025-03-05","2025-03-05","2025-07-09","2025-10-24","2024-09-30","2025-08-20","2025-07-09","2025-05-27","2025-07-30","2023-05-23","2023-05-23","2023-04-05","2023-10-31","2023-03-16","2023-06-27","2023-06-27","2023-06-27","2023-05-23","2025-09-04","2023-03-16","2025-10-09","2024-05-11","2024-09-11","2025-07-30","2023-10-17","2025-07-30","2023-07-06","2023-07-06","2023-05-26","2025-10-24","2023-01-25","2023-05-21","2025-08-20","2025-08-20","2023-07-06","2025-04-01","2022-08-30","2022-05-06","2022-05-06","2022-03-24","2022-02-24","2022-02-24"],"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":[["","","CELECOXIB","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","DESVENLAFAXINE SUCCINATE ER","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUBLOK TRIVALENT 2024-2025","","","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":{"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":""}]}]}