{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth Mccandless","gend":1,"currentgend":"","add":"86 PARTRIDGE CIRCLE","city":"Portland","state":"ME","zip":"04102","dob":"1957-05-24","age":"","mstatus":"","insh":"10000100022","cliId":"","pno":2074157573,"cno":"","email":"","ename":"","eno":"","pphy":"HEARD CUSHING, KAREN S","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","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":"86 PARTRIDGE CIRCLE","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04102","pcpfaxno":2075238597,"pcpnpi":1720421217,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8Y14NK3CT03","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M50121","M4722","M4312","L570","J209","Z01812","M2041","E785","D485","D225","L821","M2042","N281","R7401","R059","M810","M8588","M65331","M19041","Z01419","Z1151","I10","R4182","R7301","F418","R748","M24574","G5622","Z1231","Z0101","R052","J189","R5383","Z23","Z0001","Z124","N6322","N6321","H00011","L578","Z0000","M5412"],"date":["2024-05-10","2024-05-10","2024-05-10","2025-09-11","2024-03-03","2024-02-07","2024-06-07","2024-11-07","2025-01-16","2025-01-16","2025-01-16","2024-02-08","2024-01-11","2024-01-26","2024-06-28","2024-07-10","2024-03-07","2025-09-30","2025-09-30","2023-05-12","2023-05-12","2024-11-07","2024-02-13","2024-07-10","2024-07-10","2024-07-10","2024-02-13","2024-06-12","2023-05-12","2024-11-18","2023-10-02","2023-10-02","2023-10-02","2023-11-09","2025-11-07","2023-05-12","2023-05-23","2023-05-23","2025-10-17","2023-01-17","2023-10-02","2024-05-10"],"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":[["","","CEPHALEXIN","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AZITHROMYCIN","","","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":""}]}]}