{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sheila A Lavallee","gend":1,"currentgend":"","add":"196 STETSON RD","city":"Auburn","state":"ME","zip":"04210","dob":"1945-05-05","age":"","mstatus":"","insh":"10000115082","cliId":"","pno":2075766881,"cno":"","email":"declined@021825.com","ename":"","eno":"","pphy":"PARRIS, KRISTIN H","ppno":2074067600,"pcpadd":"301C US ROUTE 1,","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40749701","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"62 SHELLENBARGER RD","madd2":"","madd3":"","mcity":"Topsham","mstate":"ME","mzip":"04086","pcpfaxno":2073968632,"pcpnpi":1386632289,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6TU6M70PE66","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S8002XA","S92001B","S82871A","V892XXA","S92011D","Z0101","S81801A","Z472","X58XXXA","S82841A","M25562","Z96652","S91301D","K5900","S3609XA","F32A","I10","N3281","N952","N3941","E785","S4992XA","H532","S92001D","F331","F4322","M170","S199XXA","S0990XA","R0902","S36029A","Z452","Z4682","S299XXA","S92011B","V499XXA","S3993XA","J208","K219","S2242XA","S3991XA","S2239XD","S82872A","T07XXXA","S36031A","J9601","F339","T1490XA","S91301A","N390","K7682","R410","R262","Z736","G301","S2243XA","F03918","R4182","F418","Z043","W06XXXA","G319","Z23","S82874D","S92001A","F4323","R918","L089","R252","L97519","L814","S99911A","S80912A","S59911A","S36039A","Z8673","R270","L578","D229","L570","D492","F02B0","M2041","M79671","N1831","R451","S060XAA","F3342","G3184","S2241XD","S82871D","R8281","I6529","M160","M47816","R350","T8149XD","M25571","M6281","R4189","F05","Z01812","S82261S","R2689","W1839XD","L600","B351","M79674","M79675"],"date":["2024-07-12","2024-07-12","2024-07-12","2024-07-12","2025-09-09","2025-05-22","2024-09-24","2024-09-24","2024-09-24","2024-07-11","2024-09-02","2024-09-02","2024-11-25","2024-07-23","2024-07-12","2024-11-22","2024-12-12","2025-02-03","2024-11-27","2025-02-03","2024-11-22","2024-07-11","2025-04-18","2025-04-09","2024-11-08","2024-11-08","2025-05-07","2024-07-11","2024-07-11","2024-07-12","2024-07-11","2024-07-11","2024-07-15","2024-07-13","2024-07-12","2024-07-12","2024-07-11","2025-08-15","2024-09-24","2024-07-11","2024-07-11","2024-07-21","2024-07-11","2024-07-25","2024-07-25","2024-07-25","2024-07-25","2024-08-05","2024-09-24","2025-06-20","2024-12-26","2024-08-15","2024-11-30","2024-08-15","2025-04-09","2024-07-23","2025-10-02","2024-09-24","2024-09-24","2024-08-01","2024-08-01","2024-12-26","2025-10-20","2024-12-16","2024-12-16","2024-11-01","2024-07-17","2024-08-30","2024-10-24","2024-10-24","2024-05-01","2024-07-11","2024-07-11","2024-07-11","2024-07-11","2025-10-02","2025-10-02","2024-05-01","2024-05-01","2024-05-01","2024-05-01","2025-04-09","2025-09-09","2024-10-24","2024-06-26","2025-11-05","2024-06-05","2024-06-13","2024-06-13","2024-08-22","2024-08-22","2025-02-03","2024-06-05","2024-06-05","2024-06-05","2024-06-14","2024-10-21","2024-10-21","2024-11-30","2024-08-15","2024-08-20","2024-08-15","2024-08-20","2024-08-20","2024-08-20","2025-05-05","2025-05-05","2025-05-05","2025-05-05"],"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":[["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","VERAPAMIL HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","METHENAMINE HIPPURATE","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","GEMTESA","","","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":{"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":""}]}]}