{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paula H Boucher","gend":1,"currentgend":"","add":"82 MAIN ST","city":"WINDHAM","state":"ME","zip":"04062","dob":"1955-02-06","age":"","mstatus":"","insh":"10000108418","cliId":"","pno":2079563510,"cno":"","email":"boucher_005@yahoo.com","ename":"","eno":"","pphy":"FITZSIMMONS, MELANIE P","ppno":2078923233,"pcpadd":"MMP Lakes Regional Primary Care,584 Roosevelt Trl","pcpcity":"Windham","pcpstate":"ME","pcpzip":"04062","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE AND PED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"82 MAIN ST","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":2078930752,"pcpnpi":1700953015,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7C91YA6KG13","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F411","I872","I493","M170","I5021","S81801A","H6121","I5032","M25561","M25562","G8929","I5022","I5189","G4733","Z1231","J90","R918","H903","I83019","I420","S0990XA","I340","D860","I2510","I83891","L97919","R600","I4720","R0602","K219","E039","Z0000","I509","I517","J22","I110","Z23","L570","Z1211","R519","Z79899","S199XXA","R931","Z136","Z131","I5042","E6601","Z6843","F331","S0101XA","I5041","R591","G4719","S61412A","R001","I440","I4710","R0781","I519","R0902","I890","N816","Z4689","G4710","G44021","R0683","I10"],"date":["2025-11-04","2024-04-26","2025-11-11","2025-10-24","2025-02-18","2023-11-24","2023-11-24","2023-11-24","2025-07-15","2025-07-15","2025-07-15","2025-06-17","2025-06-17","2025-02-28","2024-01-19","2024-04-19","2024-04-19","2024-11-22","2024-04-19","2024-07-01","2023-09-02","2025-02-18","2025-10-14","2024-07-01","2024-04-19","2024-04-23","2024-04-19","2025-11-11","2024-05-07","2024-05-07","2024-10-15","2024-08-29","2024-05-16","2024-05-07","2025-01-12","2024-05-02","2023-11-24","2024-03-25","2024-03-01","2025-06-07","2024-03-28","2023-09-02","2024-05-06","2024-01-25","2024-01-25","2025-10-14","2025-10-14","2023-08-24","2023-08-24","2025-06-07","2024-05-21","2024-08-05","2024-08-05","2025-06-07","2025-06-07","2024-06-27","2024-06-27","2024-05-02","2025-02-18","2024-07-29","2024-05-04","2025-11-14","2025-11-14","2024-08-01","2024-08-01","2024-08-01","2024-05-04"],"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":[["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","GAVILYTE-G","","","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":""}]}]}