{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deanna W Mccutcheon","gend":1,"currentgend":"","add":"87 HAMILTON ST","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1958-03-02","age":"","mstatus":"","insh":"10000104834","cliId":"","pno":2073479762,"cno":"","email":"dmwmccutch@gmail.com","ename":"","eno":"","pphy":"MURRAY PULSIFER, KRISTY A","ppno":2078741489,"pcpadd":"InterMed,100 Foden Rd Ste 203","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"87 HAMILTON ST","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078741483,"pcpnpi":1356310098,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2PY6V67MP59","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G545","M25511","R202","M9901","M5412","M9903","M5416","R051","R030","M9902","M5414","M9904","M5417","R002","R918","R058","G4719","K219","R300","K2970","K449","R4182","R8290","Z23","R059","G540","R3915","I4710","I4720","Z1231","Z0001","L719","R252","R0683","R079","M79672","M79671","R262","J189","R200","Z87891","K900","R1310","R6330","H02839","K3189","K2960","M67432","Z0101","I83813","R490","J4530","J984","N3281","K5900","N952","R350","L570","L578","L720","L814","M792","J387","Z0000","Z130","I499","R233","J309","Z1211","D122","Z01419","Z90710","L900","R6889","R102","H02831","H02834","H57813","J4521","R7309","R748","R0602","Z8701","J069","J181","R0789","M50123","M4722","M4312","M6740","G5601","M8580","M47812","M8588","J0100","E559"],"date":["2024-03-19","2024-03-19","2024-03-19","2025-10-29","2025-10-29","2025-06-30","2025-06-30","2025-05-29","2025-05-29","2025-10-29","2025-10-29","2025-06-30","2025-06-30","2025-11-05","2024-02-20","2025-02-14","2024-10-10","2025-10-13","2023-11-01","2024-08-22","2024-08-22","2025-04-25","2023-08-04","2025-10-30","2024-02-14","2024-11-12","2023-09-20","2025-11-05","2025-11-05","2024-10-15","2025-10-29","2023-10-18","2023-10-18","2025-02-14","2025-10-13","2024-05-09","2024-05-09","2024-05-09","2023-08-11","2023-11-29","2025-10-13","2025-01-23","2023-12-01","2023-12-01","2023-11-08","2024-08-22","2024-08-22","2023-11-20","2025-02-27","2024-11-29","2024-07-02","2024-02-20","2023-10-25","2023-09-20","2023-07-14","2024-03-12","2024-10-04","2025-05-01","2025-05-01","2024-11-15","2024-11-15","2024-11-12","2025-10-01","2025-09-02","2023-04-14","2025-10-14","2025-09-02","2024-09-03","2025-04-25","2025-04-25","2023-10-03","2023-10-03","2023-10-03","2023-05-31","2023-06-06","2023-11-08","2023-11-08","2023-11-08","2023-08-23","2024-09-16","2024-10-10","2023-08-23","2023-08-23","2023-06-09","2023-08-02","2025-10-13","2023-08-02","2023-08-02","2023-08-02","2024-07-02","2023-12-26","2024-04-09","2023-10-18","2024-03-08","2023-06-13","2023-10-18"],"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":[["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SODIUM FLUORIDE","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","FLOVENT DISKUS","","","Select","Select",""],["","","FLOVENT HFA","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","AMOXICILLIN","","","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":""}]}]}