{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elise M Roy Hobbs","gend":1,"currentgend":"","add":"121 SILVER ST","city":"Waterville","state":"ME","zip":"04901","dob":"1941-03-23","age":"","mstatus":"","insh":"00008283500","cliId":"","pno":"2078732914","cno":"","email":"","ename":"","eno":"","pphy":"PISCULLI, JENNY T","ppno":"2078615000","pcpadd":"Maine Dartmouth Family Medicine,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2078732914","add2":"","add3":"","madd1":"121 SILVER ST","madd2":"","madd3":"","mcity":"Waterville","mstate":"ME","mzip":"04901","pcpfaxno":"2078615101","pcpnpi":"1538190384","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9YN5P78TW76","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R197","R109","R110","Z471","K5710","R1084","R634","Z9049","Z681","L308","R208","Z86007","M79605","Z96652","L300","M792","H04123","M353","M25551","M25552","M25512","R0602","I480","Z7901","I4891","Z23","R9431","H01003","H01006","H209","I083","M8580","M25471","R3989","Z8781","M8589","L820","H532","G8929","M5450","N323","R609","H5111","C4372","C779","S91302S","Z79899","G8918","M25562","R300","Z043","Z5112","L821","C4370","H02883","H02886","D2272","L03116","L97429","Z1152","I10","M1712","K8689","R079","R030","C439","R6883","R531","R262","I959","N905","R55","S99922A","M79672","N390","Z01818","R102","R509","M799","N3289","M4690","M810","Z79620","Z7952","D72828","T380X5A","D485","C774","L988","Z0000","D225","L814","W1830XA","M25762","Z08","R269","J189","L03818","Z743","L810","L570","Z1589","Z85820","F419","Z9225","T8141XA","H903","H019","S72001D","K644","K648","T189XXA","L309"],"date":["2024-02-10","2023-08-24","2023-08-24","2024-03-04","2023-05-18","2023-05-18","2023-05-25","2023-05-18","2023-05-25","2023-06-02","2023-06-14","2023-08-08","2025-03-28","2024-03-04","2023-08-08","2023-08-24","2026-02-27","2025-10-31","2023-09-20","2023-09-20","2023-09-20","2023-10-06","2025-12-02","2025-01-20","2025-01-20","2025-12-30","2023-12-13","2026-01-20","2024-09-24","2024-05-23","2023-12-13","2024-01-10","2024-02-26","2024-02-26","2024-02-26","2024-03-19","2024-03-25","2024-04-01","2024-05-31","2024-05-31","2024-05-31","2024-05-31","2024-06-10","2025-12-08","2025-10-30","2025-04-22","2025-10-30","2023-03-30","2023-03-31","2024-09-11","2023-03-31","2025-06-24","2025-07-15","2025-02-21","2026-01-20","2026-01-20","2024-12-17","2025-03-28","2025-03-28","2025-03-28","2025-08-20","2023-04-01","2023-03-21","2025-11-18","2025-11-18","2025-12-08","2025-03-28","2025-03-28","2025-03-28","2025-03-28","2026-02-26","2023-03-31","2025-03-28","2025-03-28","2025-12-18","2023-03-20","2025-03-28","2025-03-28","2025-03-28","2025-03-28","2025-03-13","2024-09-05","2024-09-05","2025-10-30","2025-05-13","2025-05-13","2024-12-17","2025-02-26","2024-12-17","2025-08-20","2025-04-08","2025-10-14","2023-03-31","2023-03-30","2025-12-10","2025-01-29","2025-03-28","2025-03-28","2025-03-28","2023-03-20","2023-03-20","2025-03-13","2025-12-10","2025-12-10","2025-12-10","2025-03-26","2025-06-26","2024-11-25","2023-03-06","2023-01-18","2023-01-18","2023-01-24","2023-01-23"],"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":[["","","DICYCLOMINE HCL","","","Select","Select",""],["","","METHOTREXATE","2.5 MG","","Select","Select",""],["","","PREDNISONE","1 MG","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","DICYCLOMINE","10 MG","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","HUMIRA PEN","","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","NITROFURANTOIN","100 MG","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Glenmark","","","Select","Select",""],["","","AMITRIPTYLINE","10 MG","","Select","Select",""],["","","METOPROLOL SUCC","50 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Prasco","","","Select","Select",""],["","","CHOLESTYRAMINE","4 GM\/DOSE","","Select","Select",""],["","","CEFPODOXIME","100 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","Ampicillin","500 MG","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","FORTEO","","","Select","Select",""],["","","TACROLIMUS","0.001","","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":""}]}]}