{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Judy Snyder Gobea","gend":1,"currentgend":"","add":"18 WALNUT DR","city":"WINDHAM","state":"ME","zip":"04062","dob":"1948-09-15","age":"","mstatus":"","insh":"10000105069","cliId":"","pno":2079398510,"cno":"","email":"jsglcsw@gmail.com","ename":"","eno":"","pphy":"LENA, SEAN R","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":"18 WALNUT DR","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":2078741483,"pcpnpi":1265895502,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9RY1D68YN80","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9900","M9901","M9902","M9903","R0600","S76012A","M1612","N289","H2512","M47816","M47812","M549","M542","M7918","R5383","R0609","Z1231","R55","S0081XA","M5450","M7912","R519","J069","I480","I3139","I314","U071","R053","I9789","Z136","I4891","K219","K2270","K259","K449","M5136","J342","J343","H04123","H40033","R059","M25552","R0989","M720","M19042","M19041","G5603","M8588","M189","F332","I499","S0990XA","R404","Z87891","M1811","G5601","G5602","I082","I77810","R931","I498","I4710","Z0001","I7300","R42","Z23","R152","R159","Z452","E039","F411","J439","J479","J8410","M85852","J449","R918","R0602","R252","J322","G2581","I6523","E782","J438","J8489","I517","I361","R079","A419","J1282","J9601","E785","Z09","H2511","H2513","H43813","J0191","R6889","Z79899","R202","S0993XA","S299XXA"],"date":["2025-10-06","2025-10-06","2025-10-06","2025-10-06","2024-12-12","2025-11-12","2025-11-12","2025-10-16","2025-07-08","2023-05-25","2025-09-02","2025-05-05","2025-06-17","2025-09-02","2025-01-17","2025-05-15","2024-12-11","2025-06-10","2024-03-24","2025-09-02","2025-09-02","2025-03-27","2023-09-22","2024-11-27","2024-11-27","2024-11-27","2024-08-25","2024-01-10","2025-02-07","2025-02-07","2025-02-07","2025-02-10","2025-02-10","2025-02-10","2025-02-10","2023-06-28","2024-04-10","2024-04-10","2024-11-05","2025-03-03","2025-05-09","2025-09-23","2023-05-23","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2024-06-21","2023-05-23","2023-05-23","2025-04-12","2025-04-11","2025-05-27","2025-04-11","2023-04-19","2023-04-19","2023-04-19","2025-05-27","2025-05-27","2025-05-27","2025-05-28","2025-05-28","2025-09-23","2023-04-07","2023-04-07","2025-09-23","2025-09-18","2025-09-18","2024-08-22","2025-10-01","2023-03-09","2025-04-09","2024-11-27","2024-05-02","2023-03-09","2024-08-19","2024-08-19","2024-08-19","2023-12-19","2024-03-06","2024-04-22","2025-06-10","2025-10-01","2024-04-11","2023-10-06","2023-02-08","2023-02-08","2023-09-02","2024-08-25","2024-08-25","2024-08-25","2023-02-08","2024-08-30","2025-06-24","2025-03-03","2025-03-03","2024-03-06","2023-04-12","2023-02-02","2024-02-07","2024-03-24","2024-03-24"],"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":[["","","FAMOTIDINE","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUVASTATIN SODIUM","","","Select","Select",""],["","","COLCHICINE","","","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":""}]}]}