{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cynthia L Lamoreau","gend":1,"currentgend":"","add":"7 SEDGLEY FIELD LN","city":"BOWDOINHAM","state":"ME","zip":"04008","dob":"1957-10-22","age":"","mstatus":"","insh":"10000104330","cliId":"","pno":2072086133,"cno":"","email":"skelton1905@yahoo.com","ename":"","eno":"","pphy":"INGER, DAVID","ppno":"","pcpadd":"Mid Coast Medical Group Topsham Internal Medicine,1 Wellness Way Ste A","pcpcity":"Topsham","pcpstate":"ME","pcpzip":"04086","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 SEDGLEY FIELD LN","madd2":"","madd3":"","mcity":"BOWDOINHAM","mstate":"ME","mzip":"04008","pcpfaxno":"","pcpnpi":1215941372,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1P79G98QH52","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z471","Z0000","G8918","M1712","K219","R4182","E6601","Z6839","R32","M5450","Z780","M1711","M79605","Z8672","Z6838","E668","Z6836","I10","R030","Z862","N3941","D649","K635","K449","K5730","D509","R143","R600","Z13820","Z96651","E66811","I803","Z713","Z1231","M25461","Z01818","M25462","Z96652","I8002","Z139","M8589","Z6834","M25562","A000","I809"],"date":["2024-12-26","2025-08-12","2024-04-22","2024-04-22","2025-08-12","2024-04-22","2024-04-22","2024-04-22","2024-04-08","2023-07-27","2023-07-27","2023-04-25","2023-12-18","2023-12-18","2023-04-25","2024-09-11","2024-09-11","2024-03-26","2025-08-12","2025-08-12","2024-08-23","2024-06-27","2024-01-11","2024-01-11","2024-01-11","2024-01-11","2024-01-12","2024-01-12","2023-09-07","2023-12-20","2025-03-19","2023-12-12","2024-10-30","2024-08-21","2023-05-09","2024-03-29","2024-05-07","2024-12-26","2023-12-06","2024-04-01","2023-09-12","2025-03-19","2024-03-26","2023-04-27","2023-12-18"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","FUROSEMIDE","","","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":""}]}]}