{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rebecca L Amsden","gend":1,"currentgend":"","add":"34 LINCOLN ST","city":"BREWER","state":"ME","zip":"04412","dob":"1956-03-02","age":"","mstatus":"","insh":"10000098274","cliId":"","pno":7703379864,"cno":"","email":"rlamsd@hotmail.com","ename":"","eno":"","pphy":"TAGUE, COURTNEY","ppno":2078664399,"pcpadd":"EMMC Orono Family Medicine,84 Kelley Rd","pcpcity":"Orono","pcpstate":"ME","pcpzip":"04473","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"34 LINCOLN ST","madd2":"","madd3":"","mcity":"BREWER","mstate":"ME","mzip":"04412","pcpfaxno":2078664538,"pcpnpi":1679953194,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7YT9EE7RC44","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z4889","S0033XA","S60222A","R918","Z981","M48061","Z87891","M2011","Z09","E785","M21611","M21612","M5136","R6889","R5381","Z7689","S0630AA","R1310","R531","M5450","R278","M2012","M2022","J449","M4802","M47812","M6281","Z1231","N393","I4710","M7731","M2141","Z713","T07XXXA","R4182","M5416","Z98890","I493","I491","R001","M5417","R2689","R930","G9389","G939","D329","I639","R9089","Z85118","I619","S161XXA","R059","Z0101","R29898","Q66212","S0990XA","R569","J441","M960","R9401","Z4789","M8589","M7989","D649","S0636AA","U071","H35373","M79671","Z5189","M2021","M5441","Z0001","R9389","S065X0A","Z0000","M810","F320","M2031","M79675","M51369","M47816","M4316","G40109","Z23","M19071","Z8669","Z86011","R0789","J439","M79651","R600","M50323","Z85841","M1712","S0993XA","J159","M160","D225","L821","L814","D2239","K769","J9811","Z8679","J479","Z299","H35341","H43813"],"date":["2024-05-03","2025-04-10","2025-04-10","2025-03-18","2025-06-04","2025-03-19","2025-06-26","2024-09-19","2025-06-26","2024-11-04","2023-04-13","2023-04-13","2024-08-14","2023-08-01","2025-04-19","2025-04-19","2025-04-19","2025-04-19","2025-01-14","2025-04-04","2025-10-02","2023-06-28","2023-06-06","2023-06-06","2024-08-14","2025-04-10","2025-11-07","2025-07-18","2024-03-05","2024-06-21","2024-09-19","2024-09-19","2023-04-28","2025-04-10","2025-04-10","2025-03-18","2023-07-21","2024-06-21","2024-06-21","2025-06-23","2025-01-14","2025-01-14","2024-12-30","2025-09-19","2024-12-30","2024-12-30","2024-12-30","2024-11-27","2024-12-18","2025-08-28","2025-04-10","2023-10-15","2025-10-10","2025-08-21","2023-06-06","2025-04-19","2025-09-19","2024-03-09","2024-12-20","2025-07-14","2024-06-14","2024-07-15","2024-06-14","2025-06-10","2025-04-10","2023-02-26","2025-10-10","2024-03-19","2025-09-15","2024-04-05","2025-05-05","2024-11-12","2023-08-23","2025-05-28","2023-11-06","2024-11-04","2024-05-16","2025-06-04","2024-12-20","2025-03-19","2025-03-19","2025-03-19","2024-11-04","2023-11-06","2025-02-26","2025-06-26","2025-06-26","2023-02-26","2024-03-09","2025-04-19","2025-04-11","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2024-03-09","2025-04-10","2023-10-17","2023-10-17","2023-10-17","2023-10-17","2024-12-18","2023-08-23","2025-05-28","2022-10-08","2022-10-04","2022-08-23","2022-08-23"],"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":[["","","LACOSAMIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LEVETIRACETAM ER","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","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":""}]}]}