{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karyn N Gerity","gend":1,"currentgend":"","add":"971 MAIN ST","city":"WATERBORO","state":"ME","zip":"04087","dob":"1958-03-19","age":"","mstatus":"","insh":"10000099883","cliId":"","pno":2077303990,"cno":"","email":"declined@10302024.com","ename":"","eno":"","pphy":"BOUCHER CORNELIO, CATHERINE","ppno":2072838800,"pcpadd":"SMHC Family Medicine,13 Industrial Park Rd Ste 2","pcpcity":"Saco","pcpstate":"ME","pcpzip":"04072","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"971 MAIN ST","madd2":"","madd3":"","mcity":"WATERBORO","mstate":"ME","mzip":"04087","pcpfaxno":2072943561,"pcpnpi":1447571864,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5E57UY4PG49","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4892","R053","F341","I483","F3489","I8311","I493","I498","I4710","I4819","J069","J329","Z0000","E039","E782","I10","Z1231","R002","M79672","E785","R4182","R931","R7309","Z780","I2510","E119","I4729","I4891","R059","J45909","R079","E1165","I080","I081","I77810","I083","J309","R9439","I484","J4540","J302","L570","S99921A","L821","L814","S51851A","Z950","R112","F419","M19072","M7732","S92411A","Z7901","I739","I459","F32A","R0602","I499"],"date":["2025-08-05","2024-01-18","2024-12-17","2025-01-16","2025-10-01","2024-12-20","2025-10-07","2025-10-07","2024-09-20","2025-11-14","2024-01-18","2024-02-15","2023-09-05","2024-10-16","2024-05-20","2025-10-16","2025-11-11","2024-12-17","2023-09-29","2024-10-16","2024-10-16","2025-09-19","2024-05-09","2024-05-02","2024-08-22","2025-02-04","2025-01-08","2025-09-19","2024-01-18","2024-03-25","2025-04-18","2025-05-29","2024-10-15","2025-09-19","2025-09-19","2025-04-29","2024-05-10","2025-03-25","2025-04-28","2024-02-15","2024-02-15","2024-02-08","2024-06-07","2024-02-08","2024-02-08","2022-12-31","2025-11-13","2024-11-27","2024-11-27","2023-09-29","2023-09-29","2024-06-07","2025-04-18","2024-05-20","2025-11-13","2024-07-15","2025-08-07","2024-10-15"],"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":[["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","DOFETILIDE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL HFA","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","DABIGATRAN ETEXILATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUARIX QUAD 2022-2023","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}