{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Theresa Cline","gend":1,"currentgend":"","add":"11 SPRING ST","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1958-02-16","age":"","mstatus":"","insh":"10000107893","cliId":"","pno":2078995793,"cno":"","email":"theresakaycline@gmail.com","ename":"","eno":"","pphy":"EDWARDS, CHRISTINA S","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 700","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":"11 SPRING ST","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2075238597,"pcpnpi":1326334335,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9U52WQ0DR27","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R208","G629","Z1231","Q8583","R222","G9389","K648","Z0000","H35372","D1809","H4312","H43392","K8050","K529","E669","Z6833","I10","H35352","E7800","R7309","R202","G959","D1802","H539","Z780","R944","R109","Z96651","M4727","R21","B029","M47816","K862","K625","K5909","N6489","M47812","M4802","M47814","M5126","R200","L821","Z6830","M7551","Z23","H04201","H02132","H02135"],"date":["2025-04-08","2025-02-11","2025-03-28","2025-09-19","2024-01-24","2025-03-28","2025-07-07","2025-02-11","2025-07-29","2025-09-19","2025-07-29","2025-04-18","2023-09-13","2025-01-07","2025-06-24","2025-01-07","2025-01-31","2025-09-19","2025-02-11","2025-02-11","2025-08-06","2025-05-13","2025-05-13","2025-05-16","2025-01-03","2025-02-11","2025-02-11","2024-01-08","2024-01-08","2025-05-07","2023-12-20","2025-02-15","2025-04-17","2025-04-17","2025-04-17","2024-01-24","2025-04-10","2025-04-10","2025-04-10","2025-03-13","2025-03-13","2024-01-30","2025-06-24","2023-12-22","2023-12-13","2023-09-28","2023-09-28","2023-09-28"],"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":[["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","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":""}]}]}