{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Geraldine R Murch","gend":1,"currentgend":"","add":"123 DUGWAY RD","city":"Bridgton","state":"ME","zip":"04009","dob":"1947-03-13","age":"","mstatus":"","insh":"10000018742","cliId":"","pno":"2076479567","cno":"6266659443","email":"gerimurch@icloud.com","ename":"","eno":"","pphy":"HIGGINS, ANDREA B","ppno":"2077745816","pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"123 DUGWAY RD","madd2":"","madd3":"","mcity":"Bridgton","mstate":"ME","mzip":"04009","pcpfaxno":"2075238597","pcpnpi":"1033777099","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5WX2CQ1MP98","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47814","M47894","L814","L821","D1801","L820","I10","M5450","M5136","M546","M1990","M9901","M9900","M9902","M9903","M47816","G8929","M4120","E890","M810","Z1231","Z0101","E213","E039","E785","L600","L602","M79674","M79675","M5126","M5137","M5451","H43812","H43392","M8589","Z780","D485","Z0100","H35371","Z0000","E559","H35361","M7918","M47817"],"date":["2023-09-20","2023-06-20","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2025-01-07","2025-03-27","2024-06-11","2023-08-10","2023-06-15","2023-08-10","2023-08-10","2023-08-10","2023-08-10","2025-01-07","2024-02-23","2023-08-10","2023-10-16","2023-10-16","2025-09-25","2023-08-15","2023-10-16","2025-03-27","2025-03-27","2026-01-28","2026-01-28","2026-01-28","2026-01-28","2024-06-11","2024-06-11","2024-06-11","2025-07-03","2025-07-03","2025-07-28","2025-07-28","2025-12-05","2025-08-28","2024-08-20","2025-01-07","2025-03-24","2025-08-28","2024-09-06","2024-09-06"],"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":[["","","TRAMADOL","50 MG","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","MNEXSPIKE","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","CYCLOBENZAPRINE","5 MG","","Select","Select",""],["","","AMLODIPINE","10 MG","","Select","Select",""],["","","EZETIMIBE","10 MG","","Select","Select",""],["","","LEVOTHYROXINE","88 MCG","","Select","Select",""],["","","GABAPENTIN","600 MG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","TIZANIDINE","4 MG","","Select","Select",""],["","","Moderna Covid-19 Vaccine","","","Select","Select",""],["","","MELOXICAM","15 MG","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Betamethasone Diprop Aug 0.05 % Cream Taro","","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","TRAMADOL HCL ER","","","Select","Select",""],["","","MODERNA COVID-","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUG","0.0005","","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":""}]}]}