{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane M Annis","gend":1,"currentgend":"","add":"92 OAKLAND ST APT B","city":"Waterville","state":"ME","zip":"04901","dob":"1944-10-11","age":"","mstatus":"","insh":"10000024802","cliId":"","pno":"2076163252","cno":2076492731,"email":"","ename":"","eno":"","pphy":"CLARK, MICHAEL E","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":"","add2":"","add3":"","madd1":"92 OAKLAND ST APT B","madd2":"","madd3":"","mcity":"Waterville","mstate":"ME","mzip":"04901","pcpfaxno":"2078615101","pcpnpi":"1053387936","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9FY1G47JY27","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0602","R059","K30","Z20822","L98499","G4733","Z9989","M79622","M25861","M1711","Z0000","E039","J449","E785","K0889","J441","F17200","I10","R634","R110","Z6836","L0390","L139","L308","L129","L120","R21","Z87891","L84","B351","M79671","M79672","M79675","M205X9","T50Z95A","F17210","I5032","I5022","E876","U071","M109","H40023","N3001","Z7952","L720","L738","H353131","R2231","M19072","M19071","Z79899","H0100A","I5030","N184","M25572","M25571","R200"],"date":["2023-04-22","2023-04-22","2023-04-14","2023-04-22","2023-04-14","2024-07-22","2023-04-14","2023-07-11","2023-07-11","2024-01-09","2024-10-14","2023-09-19","2026-02-17","2023-09-19","2023-10-11","2025-05-12","2025-05-12","2023-12-22","2023-12-22","2024-02-09","2023-12-22","2024-05-02","2024-04-17","2024-04-17","2024-04-17","2025-11-24","2024-05-07","2025-01-07","2025-05-06","2025-05-06","2025-05-06","2025-05-06","2025-03-31","2025-03-31","2025-10-13","2025-05-10","2025-08-27","2026-02-17","2024-09-16","2026-02-16","2026-02-16","2026-01-30","2024-07-31","2024-08-13","2025-01-07","2025-01-07","2026-01-30","2025-10-13","2025-01-29","2025-01-29","2025-05-06","2025-11-25","2025-12-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01"],"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":[["","","DUPIXENT","","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","AZITHROMYCIN","500 MG","","Select","Select",""],["","","Triamcinolone Acet 0.5 % Ointment Perrigo","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","LOSARTAN","50 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Lupin","","","Select","Select",""],["","","MYCOPHENOLATE","500 MG","","Select","Select",""],["","","ABRYSVO ACT-O-VIAL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","ALBUTEROL\/IPRATROPIUM","3\/0.5 MG\/3","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","SIMVASTATIN","40 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","FLUTICASONE PROP\/SALMETEROL","500\/50 MCG","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","Loteprednol 0.5 % Ophth Susp Lupin","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","LEVOTHYROXINE","100 MCG","","Select","Select",""],["","","ALLOPURINOL","100 MG","","Select","Select",""],["","","CEFUROXIME","500 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Ointment Macleods","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","TIOTROPIUM","18 MCG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","COLCHICINE","0.6 MG","","Select","Select",""],["","","Betamethasone Diprop Aug 0.05 % Ointment F","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","Hydrocortisone 2.5 % Cream Fougera","","","Select","Select",""],["","","FUROSEMIDE","80 MG","","Select","Select",""],["","","Betamethasone Diprop Aug 0.05 % Ointment A","","","Select","Select",""],["","","DULOXETINE","20 MG","","Select","Select",""],["","","BETAMETHASONE DIPROP AUG","0.0005","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.005","","Select","Select",""],["","","PREVNAR","","","Select","Select",""],["","","HYDROCORTISONE","0.025","","Select","Select",""],["","","ADVAIR DISKUS","","","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":""}]}]}