{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kelly A Currier","gend":1,"currentgend":"","add":"39 DYER RD","city":"DAYTON","state":"ME","zip":"04005","dob":"1958-02-05","age":"","mstatus":"","insh":"10000105223","cliId":"","pno":2072812923,"cno":"","email":"wizeowlkac@yahoo.com","ename":"","eno":"","pphy":"HIGGINS, ANDREA B","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":"39 DYER RD","madd2":"","madd3":"","mcity":"DAYTON","mstate":"ME","mzip":"04005","pcpfaxno":2075238597,"pcpnpi":1033777099,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1T87QM3RA37","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K5000","K50819","G894","G43E09","S46812A","Z1231","K56699","R109","N3090","R399","Z79891","H5203","H52223","H524","Z79899","M47817","G629","R921","K5080","Z780","F419","Z0000","K219","J309","K5090","F418","F1290","H903","H9313","Z1211","R6889","K50012","Z980","E781","D849","K5730","Z9049","R110","G43009","R202","Z0100","R748","R5383","Z0001","M25561","K50019","E785","R1084","K50812","E041"],"date":["2025-10-07","2025-11-12","2025-11-12","2025-11-12","2023-07-19","2024-06-04","2024-07-10","2025-02-11","2025-10-18","2025-10-18","2025-08-13","2023-06-07","2023-06-07","2023-06-07","2025-05-14","2025-02-11","2025-02-11","2025-06-11","2025-11-05","2023-10-18","2025-08-26","2025-08-04","2025-08-26","2023-06-12","2025-08-26","2025-08-13","2025-08-13","2025-02-03","2025-02-03","2025-08-26","2023-02-17","2025-08-26","2025-08-26","2025-08-04","2025-05-15","2025-07-23","2025-07-23","2025-10-07","2023-12-08","2024-07-10","2023-06-07","2025-10-07","2025-10-07","2024-07-16","2024-08-13","2025-08-26","2025-08-26","2023-03-21","2024-10-03","2024-07-16"],"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":[["","","ONDANSETRON HCL","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","TREMFYA","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NURTEC ODT","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","GEMFIBROZIL","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","BUDESONIDE DR","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","BUDESONIDE EC","","","Select","Select",""],["","","ONDANSETRON ODT","","","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":""}]}]}