{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA M BOLSTRIDGE","gend":1,"currentgend":"","add":"198 POWERSVILLE RD","city":"Medway","state":"ME","zip":"04460","dob":"1958-05-22","age":"","mstatus":"","insh":10000105283,"cliId":"","pno":2074010605,"cno":"","email":"","ename":"","eno":"","pphy":"COMSTOCK, KEVYN L","ppno":2079073030,"pcpadd":"27 State St,Ste 62","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"198 POWERSVILLE RD","madd2":"","madd3":"","mcity":"Medway","mstate":"ME","mzip":"04460","pcpfaxno":"","pcpnpi":1255356440,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4A10CF2PF04","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I517","Z5112","C50912","Z170","Z79811","Z87891","Z452","Z780","I119","Z5111","I351","I77819","C50919","E785","E039","I10","E1165","C50312","M5416","E119","R9431","R079","Z803","N6489","C50412","J9811","F331","Z0000","Z1159","Z23","E876","R110","R7401","Z0389","Z0189","Z01818","N6011","N6012","Z713","Z510","Z7984","C50812","E7849","Z0100","R3989","E782","D229","N907","L989","N6322","R922","N6325","N6324","R928","J45909"],"date":["2025-02-06","2024-12-17","2025-02-18","2024-12-17","2024-12-17","2024-12-17","2023-10-20","2024-11-25","2025-01-09","2025-02-18","2025-02-06","2025-02-06","2025-02-06","2025-02-26","2025-03-04","2025-03-04","2025-03-04","2025-03-21","2023-08-01","2024-04-30","2023-10-09","2023-10-09","2024-09-03","2023-10-19","2023-10-19","2023-10-20","2023-09-07","2024-09-11","2023-09-07","2023-09-07","2023-10-28","2023-11-01","2023-11-01","2024-01-25","2024-01-25","2024-02-12","2024-02-12","2024-02-12","2024-07-10","2024-06-03","2024-04-30","2024-05-22","2024-07-01","2024-08-19","2024-09-03","2024-09-11","2023-05-01","2023-05-01","2023-05-01","2023-08-01","2023-08-01","2023-08-01","2023-08-14","2023-08-14","2023-09-08"],"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 ODT","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PREVIDENT","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BISOPROLOL FUMARATE","","","Select","Select",""],["","","BISOPROLOL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PROMETHAZINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FLOVENT HFA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}