{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathy D Belanger","gend":1,"currentgend":"","add":"30 WATER ST APT 404","city":"Brunswick","state":"ME","zip":"04011","dob":"1945-06-03","age":"","mstatus":"","insh":"10000027174","cliId":"","pno":"2075578127","cno":"","email":"kathydbelanger@gmail.com","ename":"","eno":"","pphy":"DAVIS, MARY E","ppno":"2077955700","pcpadd":"12 HIGH ST,STE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"30 WATER ST APT 404","madd2":"","madd3":"","mcity":"Brunswick","mstate":"ME","mzip":"04011","pcpfaxno":"2077955727","pcpnpi":"1215917919","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8GD6NG0KJ68","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F411","R590","I10","E7800","R7302","K219","H109","R413","I340","H579","H10433","H524","H31102","Z961","R059","R079","U071","R531","J40","R051","Z8616","Z0000","I2510","J45909","J90","C50919","Z515","R61","G893","R918","C782","R591","C801","S0990XA","R519","R220","S0003XA","Z48813","J9811","R410","R0602","I700","C7800","J910","C50912","M19071","C384","Z170","Z853","N3944","G4700","J4530","R0600","R229","M7989","R9431","J810","F419","R350","M25571","H0102A","A000","R000","Z4682","I517","J9601","S199XXA","M47812","R92333","H43823","I499","Z136","I080","C7981","J918","J811","C761"],"date":["2024-01-09","2023-05-12","2025-07-03","2024-05-08","2023-10-23","2023-08-02","2023-10-11","2023-10-11","2023-10-23","2023-11-14","2024-01-17","2024-01-17","2025-10-29","2024-01-17","2024-02-08","2024-03-24","2024-02-08","2024-02-08","2024-03-24","2024-03-24","2024-03-24","2024-05-08","2024-05-08","2024-11-21","2026-02-16","2026-01-22","2026-01-22","2025-10-30","2025-12-09","2026-02-16","2025-08-08","2025-06-30","2025-07-28","2024-12-25","2024-12-25","2024-12-25","2024-12-25","2025-07-04","2026-02-16","2025-07-02","2026-02-16","2025-09-04","2025-07-28","2026-03-06","2025-09-07","2023-03-28","2025-07-04","2025-08-29","2026-02-16","2025-09-30","2025-06-01","2025-07-15","2026-02-16","2025-07-17","2025-07-28","2026-02-16","2026-03-06","2025-09-18","2025-12-18","2023-03-28","2025-04-23","2026-02-22","2025-06-01","2025-09-04","2026-02-16","2026-02-16","2024-12-25","2024-12-25","2025-06-25","2025-10-29","2026-02-16","2025-07-15","2026-02-16","2025-07-15","2025-07-15","2026-02-16","2025-07-17"],"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":[["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","AMITRIPTYLINE","75 MG","","Select","Select",""],["","","FLUTICASONE PROP\/SALMETEROL HFA","230\/21 MCG","","Select","Select",""],["","","POTASSIUM CL","10 MEQ","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","DEXAMETHASONE","4 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","LETROZOLE","2.5 MG","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","Olopatadine 0.1 % Ophth Sol Somerset","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Aurobindo","","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","MIRTAZAPINE","7.5 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","BUDESONIDE\/FORMOTEROL","160\/4.5 MCG","","Select","Select",""],["","","LORAZEPAM","0.5 MG","","Select","Select",""],["","","KISQALI","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","Neo\/Polymyx\/Dex 3.5\/10","","","Select","Select",""],["","","MOXIFLOXACIN","0.005","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","OLOPATADINE","0.001","","Select","Select",""],["","","NEO\/POLYMYX\/DEX","","","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":""}]}]}