{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane Laberge","gend":1,"currentgend":"","add":"40 AUTUMN LN","city":"LEWISTON","state":"ME","zip":"04240","dob":"1957-03-23","age":"","mstatus":"","insh":"10000096131","cliId":"","pno":2077549397,"cno":"","email":"dltaberge@gmail.com","ename":"","eno":"","pphy":"CLOUTIER, LISE M","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"40 AUTUMN LN","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":2077955727,"pcpnpi":1386624096,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3C50CU2TG19","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E8801","I2510","M170","J449","R6889","E6601","M25562","R519","Z0101","H47021","M25561","I6782","Z1231","Z0000","M19011","Z87891","D509","G894","F329","I10","R945","M75101","H40013","M1711","M2241","M1712","M5450","R399","L304","U071","E042","M461","F17210","R0602","M159","M7918","G4733","H47022","R52","E8342","F339","R079","E213","M5136","Z09","R29818","E119","M25462","M48061","M5117","M4727","M47816","R200","M549","M25511","M19012","M25512","M47817","G43709","E785","S43004A","S46012D","H532","M51370","R2242","H40023","H5203","H25813","Z780","R0789","R0609","K219","R531","M7581","G9009","E041","Z20822","H903","D23112","D23121","E559"],"date":["2023-04-12","2025-06-09","2024-10-18","2023-04-12","2023-08-09","2024-08-19","2025-01-26","2025-10-14","2023-08-09","2023-08-09","2025-01-17","2025-10-21","2025-10-25","2025-03-07","2025-04-02","2025-10-24","2025-11-04","2023-10-20","2023-07-10","2024-08-19","2023-07-10","2024-06-19","2024-03-07","2023-09-22","2023-09-22","2025-03-06","2024-02-12","2024-02-12","2024-02-12","2024-09-20","2024-02-02","2024-08-08","2023-08-08","2025-10-08","2023-09-20","2023-09-20","2023-12-19","2023-11-15","2024-08-08","2025-10-09","2023-08-22","2025-06-09","2023-03-08","2024-06-04","2023-03-31","2025-10-21","2025-09-19","2025-01-26","2024-07-28","2024-07-28","2024-07-28","2025-10-08","2024-06-05","2025-10-08","2025-04-02","2023-09-22","2023-09-22","2024-07-28","2024-08-19","2023-11-22","2025-04-02","2025-04-02","2025-10-24","2025-10-08","2024-06-05","2025-02-24","2024-09-09","2024-09-09","2023-10-09","2022-10-19","2022-09-22","2022-09-19","2022-09-19","2022-09-28","2022-07-26","2022-07-22","2022-08-05","2022-06-30","2022-05-24","2022-05-24","2022-04-15"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","NABUMETONE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OXYCODONE HCL","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":[]}]},{"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":""}]}]}