{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brenda W Lovley","gend":1,"currentgend":"","add":"12 CLARK FALLS RD","city":"ORRINGTON","state":"ME","zip":"04474","dob":"1957-05-19","age":"","mstatus":"","insh":"10000096536","cliId":"","pno":2079441720,"cno":"","email":"brendabun@gmail.com","ename":"","eno":"","pphy":"PEPPER, CINDY E","ppno":2074697371,"pcpadd":"110 BROADWAY,","pcpcity":"BUCKSPORT","pcpstate":"ME","pcpzip":"44164612","pcpcounty":"","pcpid":"","pcpname":"BUCKSPORT REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 CLARK FALLS RD","madd2":"","madd3":"","mcity":"ORRINGTON","mstate":"ME","mzip":"04474","pcpfaxno":"","pcpnpi":1104867290,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8HP7DW2VK68","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E039","R739","I10","Z139","M542","M47812","M4802","Z23","R7989","L710","Z0000","N393","N3289","N390","R319","M5023","Z1211","Z1231","H43813","H538","H25813","K640","M2012","M2142","M24575","M25375","I499","G8921","K219","T8484XA","Z0101","H5213","H524","H52223","M2022","L02214","R32","L03319","K439","R140","T8484XD","R1084","R591","H903","H2513","R6889","J45909","E669","M7742","M2042","M2062","M76822","G8918","M21612","Z01812","G8929","K2970","M8588","Z13820","M5450"],"date":["2025-09-08","2025-07-22","2025-07-22","2023-06-06","2024-10-28","2024-10-28","2024-10-28","2024-10-17","2024-03-29","2023-07-13","2025-10-21","2024-03-26","2024-02-29","2024-10-16","2024-10-16","2024-01-09","2024-11-13","2025-10-13","2025-10-06","2025-10-06","2025-10-06","2024-11-13","2024-08-13","2022-12-27","2022-12-27","2022-12-27","2024-02-09","2024-01-09","2023-05-18","2024-08-13","2025-10-29","2025-10-29","2025-10-29","2025-10-29","2024-05-30","2023-02-24","2024-03-25","2023-02-22","2023-07-18","2023-05-25","2024-04-19","2024-04-12","2024-04-12","2025-10-10","2023-06-12","2023-11-02","2024-04-26","2024-04-26","2022-10-14","2022-10-14","2022-10-14","2022-10-06","2022-10-14","2022-10-14","2022-10-06","2022-08-26","2022-08-26","2022-09-08","2022-09-08","2022-07-05"],"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":[["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","LIOTHYRONINE SODIUM","","","Select","Select",""],["","","LEVALBUTEROL TARTRATE HFA","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","VALSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}