{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jacqueline Coffin","gend":1,"currentgend":"","add":"65 BONNY EAGLE POND RD","city":"STANDISH","state":"ME","zip":"04084","dob":"1957-09-01","age":"","mstatus":"","insh":"10000099364","cliId":"","pno":2078410119,"cno":"","email":"jackie.coffin@icloud.com","ename":"","eno":"","pphy":"BUCHBERGER, GLENN K","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 700","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"65 BONNY EAGLE POND RD","madd2":"","madd3":"","mcity":"STANDISH","mstate":"ME","mzip":"04084","pcpfaxno":2075238597,"pcpnpi":1598054702,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5W08Y36FT23","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F4323","Z01419","Z1151","L570","G4710","M1811","R413","Z0001","S63041A","Z736","Z4789","Z23","F329","F411","E7800","H6691","E785","J45909","L821","L814","L308","L578","D225","Z872","Z124","Z1389","K635","Z800","Z0101","I10","R6889","Z1231","M720","N952","Z0000","Z1211","D125","Z0100","R2230","M1711"],"date":["2025-11-04","2023-03-09","2023-03-09","2024-01-09","2025-04-21","2023-01-18","2025-07-21","2025-04-02","2023-03-21","2023-03-21","2023-03-21","2023-02-01","2023-02-01","2023-02-01","2025-04-15","2024-12-05","2023-10-11","2023-10-11","2025-04-08","2023-01-10","2023-01-10","2025-04-08","2025-04-08","2025-04-08","2025-04-01","2023-03-09","2023-10-11","2023-10-11","2025-07-24","2025-04-15","2023-05-10","2025-04-01","2024-04-24","2025-04-01","2024-02-07","2023-10-11","2023-10-11","2024-07-22","2024-03-15","2023-05-10"],"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":[["","","BUSPIRONE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHET ER","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","VYVANSE","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","ADVAIR DISKUS","","","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":""}]}]}