{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean M Tinkham","gend":1,"currentgend":"","add":"20 JUNIPER LN UNIT 23","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1949-05-31","age":"","mstatus":"","insh":"10000097728","cliId":"","pno":2075910172,"cno":"","email":"jeantinkham49@icloud.com","ename":"","eno":"","pphy":"WARD, HANNAH","ppno":"","pcpadd":"66 BRAMHALL ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41023344","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 JUNIPER LN UNIT 23","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":"","pcpnpi":1932692803,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2GJ6YH2QH62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J441","M810","Z79899","Z96642","R319","R45851","F99","R531","I10","M4854XA","F17200","R069","R4182","I8393","I7140","Z471","J449","Z9181","H2513","H53001","F1090","R627","J439","M1612","N939","M25552","L989","J189","R0602","R1310","S72002A","W19XXXA","R410","Z59819","Z1151","S22080D","F32A","R634","Z8639","K6389","N281","C541","M7989","F17219","S22049D","S22060D","S22040D","I7143","R1900","N3000","M80052A","F10129","Z0100","S0990XA","S199XXA","F419","Y909","F17290","Z1231","Z23","M80052D","R112","R197","R4189","Z0279","R918","Z720","S3991XA","S3993XA","S72002D","F17210","M5450","S3992XA","S299XXA","S22050D","S7292XA","F0390","Z7189","F19951","F339","G9340","Z008","N390","R600","R070","R413","E8342","M25562","L304","K649","G8918","K2289","S22080A","T148XXA","R0781","R000","M546","S22049A","S22059A","S22069A","N950","H25811","R5383","S79912A","M6289","M79605","I080","K224","F418","I7141","R310","S22050B","F331","M25561","Z87891","Z122","R059","R58","R7401","R0989"],"date":["2025-01-25","2025-09-12","2025-09-12","2025-06-10","2025-05-14","2024-11-24","2024-11-24","2024-11-11","2024-10-23","2023-03-16","2025-06-10","2024-11-25","2025-07-21","2025-03-18","2025-07-01","2025-06-10","2025-08-18","2025-01-30","2024-07-30","2024-07-30","2025-01-17","2025-01-22","2025-06-10","2025-10-16","2025-04-03","2025-05-20","2025-09-22","2024-07-20","2024-11-25","2025-01-21","2025-06-13","2024-06-17","2025-01-22","2024-11-26","2025-04-30","2023-07-06","2023-04-06","2023-05-02","2025-04-16","2025-10-31","2025-10-31","2025-09-25","2025-10-21","2024-06-18","2023-07-06","2023-07-06","2023-07-06","2025-08-21","2025-08-21","2024-01-27","2024-06-17","2024-11-24","2023-07-25","2024-07-18","2024-06-17","2024-11-24","2024-11-24","2024-11-24","2023-10-10","2025-04-21","2024-08-19","2024-11-11","2025-10-31","2024-12-26","2024-12-26","2025-07-09","2025-07-09","2024-06-17","2024-06-17","2024-07-01","2024-11-11","2023-03-16","2023-03-15","2024-06-17","2023-03-16","2024-06-19","2025-01-17","2025-01-17","2023-03-18","2023-03-18","2024-12-10","2024-12-10","2025-05-14","2025-08-18","2024-02-19","2025-09-22","2025-09-22","2023-12-01","2023-12-21","2023-12-12","2024-06-17","2024-03-27","2023-03-27","2024-06-06","2023-12-01","2023-12-01","2023-03-18","2023-03-18","2023-03-18","2023-03-18","2025-04-30","2023-09-22","2024-11-25","2024-06-16","2023-12-06","2025-10-21","2024-06-17","2024-10-09","2025-07-21","2025-07-25","2025-05-05","2023-03-16","2024-10-23","2024-10-23","2022-10-05","2022-10-05","2022-09-21","2022-09-21","2022-09-21","2022-08-25"],"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":[["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","TERIPARATIDE","","","Select","Select",""],["","","RAMELTEON","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","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":""}]}]}