{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tina Ingraham","gend":1,"currentgend":"","add":"52 SIGNATURE DR","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1947-03-19","age":"","mstatus":"","insh":"10000017972","cliId":"","pno":"7034636043","cno":"","email":"tina.g.ingraham@gmail.com","ename":"","eno":"","pphy":"FUCHS ERTMAN, DEBRA","ppno":"2077745816","pcpadd":"100 GANNETT DRIVE,SUITE C","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"52 SIGNATURE DR","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":"2078741483","pcpnpi":"1730158403","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2EN2GR4HU24","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M170","M5432","E785","R030","F4310","J4540","H02402","M9900","M9901","M9902","M9903","M542","K589","R102","M549","M25552","M25561","M6281","J9811","M9904","J181","D472","R918","R768","Z1231","M810","M8588","M1812","M1811","G5603","H5712","M1612","R911","M47817","Z23","M5127","M5451","R262","R229","K449","R9389","R5383","M5450","M546","R222","L814","L439","D492","L820","L570","Z760","M47816","M7918","M48061","M19011","M67911","M65312","M25511","E7800","Z0001","Z01811","Z98890","Z4682","J90","J982","J939","F418","R4182","I4811","J8410","Z48813","I081","I480","I10"],"date":["2023-06-08","2023-11-17","2024-06-05","2023-06-15","2024-07-09","2023-06-22","2023-07-26","2024-06-21","2024-06-21","2024-06-21","2024-06-21","2024-01-05","2024-01-05","2024-01-05","2023-11-20","2024-01-15","2023-11-20","2024-05-30","2023-09-28","2024-05-07","2023-09-28","2023-10-11","2023-12-07","2023-10-11","2023-10-23","2023-12-07","2023-10-23","2023-10-19","2023-10-19","2023-10-19","2023-11-10","2023-11-17","2024-06-17","2023-12-16","2024-05-10","2023-12-16","2024-04-02","2024-04-02","2024-02-27","2024-02-22","2024-03-05","2024-06-21","2024-06-21","2024-06-21","2024-02-27","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-02-05","2024-02-05","2024-02-05","2024-04-18","2024-05-30","2024-04-18","2024-05-30","2024-06-11","2024-05-10","2024-05-22","2024-06-06","2024-06-06","2024-06-17","2024-06-06","2024-06-07","2024-06-05","2024-06-05","2024-06-26","2024-06-05","2024-06-17","2024-06-26","2024-06-25","2024-06-07"],"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":[["","","Tretinoin 0.025 % Cream Actavis","","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Breo Ellipta","","","Select","Select",""],["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Shingrix","","","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":""}]}]}