{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Betty L Lebel","gend":1,"currentgend":"","add":"550 COLLEGE ST UNIT 237","city":"Lewiston","state":"ME","zip":"04240","dob":"1948-09-02","age":"","mstatus":"","insh":"10000026999","cliId":"","pno":"2072122752","cno":"","email":"bnlebel48@gmail.com","ename":"","eno":"","pphy":"SHEIKH, MUHAMMAD A","ppno":"","pcpadd":"1100 TRANCAS ST STE 256,","pcpcity":"NAPA","pcpstate":"CA","pcpzip":"94558292","pcpcounty":"","pcpid":"","pcpname":"ST MARYS MEDICAL ASSOCIATES","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2073185612","add2":"","add3":"","madd1":"550 COLLEGE ST UNIT 237","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":"7072511706","pcpnpi":"1235252859","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5JG5E08YY53","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F411","M9901","M9902","M9904","M542","G4733","E785","I208","I10","R262","M25551","M7601","Z79631","R0600","Z5181","J4520","Z79899","F419","L400","M25512","G8929","M19012","Z1231","Z0000","J4530","R918","S46012D","M75112","M24112","M67814","Z0101","D2372","R0609","D485","M75102","G8918","M7522","S46292D","Z4789"],"date":["2024-07-10","2024-05-08","2024-05-08","2024-05-08","2024-05-08","2024-07-11","2023-06-15","2023-06-15","2023-06-15","2023-08-18","2023-08-18","2023-08-18","2023-09-27","2023-11-17","2023-08-16","2024-05-16","2024-03-21","2023-09-01","2024-06-26","2024-07-11","2024-05-14","2024-02-13","2023-11-18","2023-10-24","2023-11-17","2023-11-17","2023-12-18","2024-05-22","2024-02-13","2024-02-13","2024-03-28","2024-03-21","2024-02-13","2024-03-21","2024-07-11","2024-05-22","2024-05-22","2024-07-11","2024-07-11"],"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":[["","","Methotrexate","2.5 MG","","Select","Select",""],["","","Hydroxyzine Pam","25 MG","","Select","Select",""],["","","Mupirocin 2 % Ointment Teva","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Nyamyc","","","Select","Select",""],["","","Clobetasol 0.05 % Foam Taro","","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Cyclosporine Pf 0.05 % Ophth Emuls Kvk-Tec","","","Select","Select",""],["","","Ilumya","","","Select","Select",""],["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Buspirone","15 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Otezla","","","Select","Select",""],["","","Breo Ellipta","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Bupropion Hcl","150 MG","","Select","Select",""],["","","Skyrizi","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Baclofen","10 MG","","Select","Select",""],["","","Buspirone Hcl","","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","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":""}]}]}