{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbara H Whiton","gend":1,"currentgend":"","add":"32 PINECREST RD","city":"PORTLAND","state":"ME","zip":"04102","dob":"1957-09-06","age":"","mstatus":"","insh":"10000098581","cliId":"","pno":2072722495,"cno":"","email":"barbarah.whiton@gmail.com","ename":"","eno":"","pphy":"STATON, MEGAN","ppno":2078741489,"pcpadd":"100 FODEN RD. WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062327","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"32 PINECREST RD","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04102","pcpfaxno":2078741483,"pcpnpi":1235249137,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1AW7R58AJ33","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z510","C50311","S73102D","C50111","S73191D","I972","C50919","Z79899","Z23","D242","Z0001","M5030","M47812","R053","M160","F54","Z0101","R928","F4323","M47816","G44209","M542","Z170","M8580","M5450","M1611","C50811","J0110","Z0184","N6489","R7303","N6452","Z853","M8588","Z08","Z923","M25551","R351","Z1231","H00015","H02844","H5213","D0511","N6042","Z0000","Z135","H3589","M25559","R6889","R030","M19071","M79671","M1250","M84374A","Z4889","R4182","J069","R059","R509","N6011","M79605","C50812","J0190","Z98890","F331","F4312"],"date":["2023-12-14","2025-06-25","2025-02-18","2025-02-18","2025-02-18","2024-07-26","2024-07-26","2024-05-02","2025-09-11","2023-10-04","2025-02-12","2025-09-11","2025-11-10","2025-02-12","2025-05-20","2024-08-14","2025-03-24","2023-09-26","2023-06-07","2025-11-10","2025-11-10","2025-09-11","2024-10-16","2024-10-16","2025-09-11","2025-06-04","2023-10-04","2025-01-04","2025-04-17","2024-06-25","2023-05-15","2023-10-04","2024-10-07","2023-12-08","2024-05-22","2024-08-01","2025-05-20","2025-02-12","2024-08-01","2024-06-05","2025-02-06","2024-03-19","2023-08-28","2023-08-28","2023-01-26","2025-03-24","2025-03-24","2025-05-20","2023-06-02","2023-02-03","2023-07-19","2023-06-14","2023-06-14","2023-07-19","2023-11-06","2023-10-04","2024-10-07","2024-10-07","2024-10-07","2023-06-29","2023-01-19","2023-10-04","2022-11-22","2022-11-11","2022-10-21","2022-10-21"],"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":[["","","ANASTROZOLE","","","Select","Select",""],["","","EXEMESTANE","","","Select","Select",""],["","","LETROZOLE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":[]}},{"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":""}]}]}