{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Denise D Fraser","gend":1,"currentgend":"","add":"44 SEVENTEENTH ST","city":"BANGOR","state":"ME","zip":"04401","dob":"1954-08-01","age":"","mstatus":"","insh":"10000107203","cliId":"","pno":2073123933,"cno":"","email":"denisedorisfraser@gmail.com","ename":"","eno":"","pphy":"SMITH SANDILANDS, NICOLE J","ppno":2079073300,"pcpadd":"PO BOX 1599,","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"44 SEVENTEENTH ST","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":2079071923,"pcpnpi":1134297765,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3UG9KX4ND46","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","I10","E119","M4722","E539","Z23","M7918","S0231XA","E782","R5382","D229","M7072","F321","M24541","M19041","R1032","L814","L821","E559","M159","M797","M720","M542","M7551","Z1231","Z780","H903","M47816","M7552","M5116","M19011","S0990XA","S0591XA","W228XXA","M5412","E663","M19012","M5011","K5090","R6889","M5416","Z0101","H52223","H524","M48061","M5127","M47817","H5203","T797XXA","W010XXA","M25552"],"date":["2025-04-01","2025-11-04","2025-11-04","2025-06-08","2025-07-03","2023-12-12","2025-04-01","2023-11-25","2023-12-12","2024-03-08","2024-07-10","2025-02-03","2025-07-10","2023-08-17","2023-08-17","2024-12-30","2024-07-10","2024-07-10","2025-11-04","2023-12-21","2023-05-31","2023-05-31","2025-04-01","2024-08-08","2025-05-09","2025-05-09","2025-04-11","2023-07-08","2024-08-08","2023-08-14","2025-05-13","2023-11-25","2023-11-25","2023-11-25","2025-07-03","2024-03-08","2024-11-11","2025-04-04","2023-12-21","2023-08-03","2023-06-22","2025-01-27","2025-01-27","2025-01-27","2023-07-08","2023-07-08","2023-07-08","2025-01-27","2023-11-25","2023-11-25","2024-12-30"],"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",""],["","","PREGABALIN","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","TWINRIX","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":[]}},{"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":""}]}]}