{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda T Wise","gend":1,"currentgend":"","add":"283 STICKNEY HILL RD","city":"ATHENS","state":"ME","zip":"04912","dob":"1943-03-24","age":"","mstatus":"","insh":"00008094700","cliId":"","pno":"2073994957","cno":"2073994957","email":"Shambhala.wise@gmail.com","ename":"","eno":"","pphy":"WALLACE, NICOLETTE","ppno":"","pcpadd":"35 OLDE SCHOOL LN UNIT 104,","pcpcity":"SKOWHEGAN","pcpstate":"ME","pcpzip":"49761263","pcpcounty":"","pcpid":"","pcpname":"SOMERSET PRIMARY CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"283 STICKNEY HILL RD","madd2":"","madd3":"","mcity":"ATHENS","mstate":"ME","mzip":"04912","pcpfaxno":"","pcpnpi":"1881426211","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3E19C20AW37","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","I6930","I10","I6523","R002","Z0000","I639","Z1212","Z1211","I4891","M549","G894","Z1231","N1832","M25552","R29898","L84","S7002XA","L602","M79675","L858","M9901","M542","M5412","M5030","M2041","N390","I129","G8192","N3281","J449","J670","I4820","I480","E538","R82998","J383","I130","I351","M48061","M5126","M47816","J309","R0602","I509","R8290","R300","I5032","J9809","R791","I4819","J9811","Z5181","R159","N8189","N3941","U071","R296","I4821","Z7901","L859","M79604","G629","R519","I5030","N816","Z90710","Z87440","I672","G9389","R319","R531","K5730","K449","R059","R9089","M51369","R1314","I499","E785","R011","R0600","C729","G939","R2689","R42","R900","F32A","N281","N2889","G319"],"date":["2026-02-03","2023-04-20","2026-02-03","2025-07-02","2023-05-26","2025-07-23","2023-05-22","2023-06-04","2023-06-04","2026-02-18","2023-09-18","2024-04-03","2023-10-13","2023-08-28","2023-10-23","2023-08-09","2025-12-08","2023-10-23","2023-11-14","2023-11-14","2024-11-13","2024-03-11","2025-07-02","2024-03-11","2024-03-11","2024-01-31","2025-12-16","2024-06-04","2025-11-10","2025-11-07","2026-02-25","2026-02-15","2025-12-31","2026-02-25","2025-11-19","2024-07-24","2025-12-22","2026-02-12","2025-10-01","2025-10-27","2025-10-27","2025-10-27","2025-10-28","2025-10-28","2026-01-30","2025-01-30","2025-12-23","2026-02-03","2026-01-30","2026-01-19","2026-02-25","2026-01-21","2024-11-27","2025-12-11","2025-12-11","2025-12-11","2026-01-04","2023-03-29","2024-10-07","2026-02-25","2025-05-20","2025-08-06","2025-10-02","2025-07-02","2025-09-22","2025-10-01","2025-10-01","2025-10-01","2025-09-03","2025-09-03","2025-05-22","2025-09-03","2026-02-12","2026-02-12","2024-12-09","2023-03-21","2026-02-05","2026-02-10","2026-02-25","2026-02-25","2026-02-25","2026-02-12","2023-03-16","2023-01-30","2023-01-30","2023-01-30","2023-01-27","2023-01-19","2023-01-27","2023-01-27","2023-01-27"],"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":[["","","MYRBETRIQ","","","Select","Select",""],["","","WARFARIN","1 MG","","Select","Select",""],["","","DEXAMETHASONE","6 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","500\/125 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","TOLTERODINE","2 MG","","Select","Select",""],["","","Gemtesa","","","Select","Select",""],["","","Procto-Med Hc","","","Select","Select",""],["","","Mirabegron","50 MG","","Select","Select",""],["","","PREGABALIN","100 MG","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","AMIODARONE","200 MG","","Select","Select",""],["","","FOSFOMYCIN","3 GM","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","LEVOTHYROXINE","125 MCG","","Select","Select",""],["","","MELOXICAM","7.5 MG","","Select","Select",""],["","","Digoxin","0.125 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","METOPROLOL TART","50 MG","","Select","Select",""],["","","DILTIAZEM","60 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","CEFADROXIL","500 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","AMOXICILLIN","875 MG","","Select","Select",""],["","","LYRICA","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","METOLAZONE","2.5 MG","","Select","Select",""],["","","TORSEMIDE","20 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","OXYBUTYNIN","15 MG","","Select","Select",""],["","","DULOXETINE","30 MG","","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":""}]}]}