{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathy M Crossman","gend":1,"currentgend":"","add":"67 CLARK HILL RD","city":"HOLDEN","state":"ME","zip":"04429","dob":"1958-05-14","age":"","mstatus":"","insh":"10000106585","cliId":"","pno":2079444899,"cno":"","email":"kathycrossman@gmail.com","ename":"","eno":"","pphy":"BARBEE, KRISTEN","ppno":2075462391,"pcpadd":"ONE MEDICAL CENTER DRIVE,","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"04005","pcpcounty":"","pcpid":"","pcpname":"MILBRIDGE MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"67 CLARK HILL RD","madd2":"","madd3":"","mcity":"HOLDEN","mstate":"ME","mzip":"04429","pcpfaxno":2072846291,"pcpnpi":1215166533,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9UG2AJ6TG09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D801","J069","R439","M5412","J0101","R430","R432","B9689","R413","M9901","M5382","M9902","M546","M7918","Z0000","Z0101","M5030","J3489","R6889","N393","E785","R9082","Z9089","J189","D509","Z1211","R12","R1310","K2080","N898","Z1231","F4322","D803","Z0189","K319","K2100","K635","I6523","R0989","I10","M8589","J342"],"date":["2024-11-12","2023-08-25","2023-09-25","2023-06-20","2024-08-13","2024-08-13","2024-08-13","2024-08-13","2024-11-19","2024-01-29","2024-01-29","2024-01-29","2024-01-29","2023-11-16","2024-12-09","2025-08-12","2024-11-12","2024-01-09","2023-12-18","2025-09-09","2025-06-20","2024-07-01","2024-07-01","2025-04-04","2024-05-06","2023-06-14","2023-06-14","2023-09-25","2023-06-14","2025-07-30","2025-04-16","2023-08-11","2023-05-05","2023-05-05","2023-06-14","2023-06-14","2023-06-14","2023-11-17","2023-11-17","2025-06-20","2024-04-15","2024-01-09"],"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":[["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHET ER","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","TROSPIUM CHLORIDE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PNEUMOVAX 23","","","Select","Select",""],["","","CAPVAXIVE","","","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":""}]}]}