{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy F Beasley","gend":1,"currentgend":"","add":"116 PURITAN DR","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1958-09-22","age":"","mstatus":"","insh":"10000108326","cliId":"","pno":2078549412,"cno":"","email":"nandougb@gmail.com","ename":"","eno":"","pphy":"FUCHS ERTMAN, DEBRA","ppno":2077745816,"pcpadd":"100 GANNETT DRIVE,SUITE C","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"116 PURITAN DR","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":2078741483,"pcpnpi":1730158403,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3K65WD8RE78","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M19011","M89319","Z96612","Z0001","E119","M5442","M79605","H401131","Z0101","E7800","R7303","Z1159","K900","E039","Z114","R222","M25552","R109","K5730","E1169","I10","E6609","Z6839","Z96642","Z1231","E8352","Z23","E1165","R200","M6281","M62838","R7989","R221"],"date":["2025-06-30","2025-07-23","2024-05-16","2024-10-31","2024-10-31","2024-06-18","2024-06-18","2025-05-05","2025-05-05","2024-10-31","2023-10-16","2023-10-16","2023-10-16","2025-01-10","2023-10-16","2025-07-23","2024-06-06","2024-06-06","2024-06-06","2025-04-04","2025-03-28","2025-03-28","2025-03-28","2024-06-10","2025-09-23","2023-10-24","2023-10-16","2024-02-29","2024-07-16","2024-07-16","2024-07-16","2023-12-13","2025-07-02"],"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":[["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","ONETOUCH VERIO FLEX METER","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","LEVOXYL","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","CYCLOSPORINE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}