{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy L Graham","gend":1,"currentgend":"","add":"20 DUNNING BLVD","city":"BANGOR","state":"ME","zip":"04401","dob":"1938-05-25","age":"","mstatus":"","insh":"10000101767","cliId":"","pno":2079429067,"cno":"","email":"njgbgr20@gmail.com","ename":"","eno":"","pphy":"BARTLETT, TERESA M","ppno":2079073300,"pcpadd":"St Joseph Healthcare Internal Medicine,900 Broadway","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 DUNNING BLVD","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":2079071923,"pcpnpi":1386980829,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7C85AF7HF81","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","L719","I10","Z9181","R1031","M160","M5136","M47817","M4316","M25551","R6889","G40909","S299XXA","S8991XA","R051","M5416","Z79899","G629","M79604","M48061","E7800","D225","L821","L814","Z7189","L820","R208","L538","L298","L570","Z0000","R079","M79661","R0781","L309","M25561","M4807","M5126","M51360","M546","H353134","H43813","H40053","M7061","G8929","G5701","R0789","I96","R0602","G40409","E782","H0014","H353131","Z0101","H5213","G6289","I088","R011","M5116","M4726","L2089","M5441","D2261","D485","Z789","R252","S79911A"],"date":["2025-08-23","2025-06-27","2024-12-12","2023-07-28","2023-07-28","2023-07-28","2023-07-28","2025-08-23","2023-08-18","2025-08-06","2023-07-03","2024-10-24","2023-02-15","2023-02-17","2024-11-05","2025-04-10","2024-04-29","2024-04-29","2025-08-06","2025-04-10","2024-07-22","2025-01-30","2025-01-30","2025-01-30","2024-01-25","2024-01-25","2024-01-25","2024-01-25","2024-01-25","2024-01-25","2025-01-30","2023-03-17","2023-11-28","2024-12-12","2024-12-12","2023-02-17","2025-08-23","2025-08-23","2025-08-23","2025-08-04","2025-04-08","2024-07-10","2023-06-23","2024-07-30","2025-08-06","2024-08-05","2023-02-17","2023-01-20","2025-05-23","2025-01-28","2024-07-24","2025-07-29","2024-07-10","2024-07-10","2024-07-10","2024-04-10","2025-06-20","2025-01-28","2023-08-18","2023-08-18","2025-01-30","2023-09-20","2023-01-20","2023-01-20","2023-01-20","2023-11-28","2024-04-02"],"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":[["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":""}]}]}