{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vicki A Camire","gend":1,"currentgend":"","add":"17 CHADBOURNE RD","city":"Lewiston","state":"ME","zip":"04240","dob":"1955-04-26","age":"","mstatus":"","insh":"10000015588","cliId":"","pno":"2072400319","cno":"","email":"VICKI17@YMAIL.COM","ename":"","eno":"","pphy":"POULIN, JOSEPHINE","ppno":"","pcpadd":"Sebasticook Family Doctors,29 Church St","pcpcity":"Dexter","pcpstate":"ME","pcpzip":"04930","pcpcounty":"","pcpid":"","pcpname":"ST MARYS MEDICAL ASSOCIATES","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"17 CHADBOURNE RD","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":"2075242093","pcpnpi":"1114480860","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5X96YJ1DU53","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M7552","M170","E559","E119","H2513","H35371","H43811","H35363","M25512","G8929","Z0000","Z1231","M25561","M25562","G4733","N6489","R921","H25013","H2511","I10","E118","H2512","H25012","H25011","H35353","H35351","E042","E6601","Z6835","J9811","J189","J0190","Z87891","H02831","H02834","H57813","H04123","R6889","Z961","E041","Z780","M8588","E1122","Z01818"],"date":["2023-04-07","2024-04-17","2023-04-07","2023-10-13","2023-07-24","2023-04-20","2023-04-20","2023-04-20","2023-04-21","2024-02-14","2024-04-18","2023-04-28","2024-04-17","2024-04-17","2024-05-22","2023-05-30","2023-05-30","2023-07-24","2023-09-05","2023-09-05","2023-09-05","2023-09-12","2023-09-12","2023-09-05","2023-11-16","2023-12-18","2023-12-13","2024-04-18","2024-04-18","2024-01-15","2024-01-15","2024-01-15","2024-01-15","2024-06-26","2024-06-26","2024-06-26","2024-02-15","2023-10-13","2023-10-13","2024-03-20","2024-05-01","2024-05-01","2024-06-06","2024-06-18"],"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":[["","","Triamterene\/Hydrochlorothiazide","75\/50 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Cefadroxil","500 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Pregabalin","75 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","Rosuvastatin","40 MG","","Select","Select",""],["","","Levothyroxine","25 MCG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Dexamethasone","4 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Sandoz","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Ozempic","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Meloxicam","7.5 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":""}]}]}