{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia H Berger","gend":1,"currentgend":"","add":"2 MAY WAY","city":"SIDNEY","state":"ME","zip":"04330","dob":"1948-09-07","age":"","mstatus":"","insh":"10000027500","cliId":"","pno":"2076499295","cno":"","email":"thepondrd@roadrunner.com","ename":"","eno":"","pphy":"LEBLANC, CHRISTINA","ppno":"2078731098","pcpadd":"MaineGeneral Medical Center,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"THAYER INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 667","madd2":"","madd3":"","mcity":"OAKLAND","mstate":"ME","mzip":"04963","pcpfaxno":"2078615461","pcpnpi":"1154773935","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3EA5NV4KJ66","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C9110","Z5112","D801","R61","D849","N951","R1084","R112","Z86010","H524","H25093","H43813","R110","Z515","M79662","S82302A","S82462A","Z0001","M79606","F32A","E039","E673","F4320","K2100","Z79899","R600","M79605","Z856","S82202A","S82402A","X58XXXA","I6523","I10","G9389","R29810","R9089","I6521","I708","Z0389","R531","G459","R29818","Z09","I082","I4710","I493","R0602","R000","R5383","Z87891","Z8249","R0683","I083","N3941","I2720","K219","J439","Z8673","N8110","R197","Z0000","Z01810","R159","N393","R5382","R931","Z8701","I491","R0600","I2510","R0609","I639","H52223","R1310","R918","J449","R0789","R059","R509","R079","R7989","J189","J918","Z4682","R9389","J9811","M47816","R7881","M48061","M5124","J90","K760","N281","K8689","K769","B953","D84821","J440","Z20822","K317","K2090","R140","R109","K2289"],"date":["2026-03-05","2023-04-03","2026-03-05","2023-10-31","2023-04-19","2023-06-26","2023-10-27","2023-07-26","2023-07-26","2025-02-03","2025-02-03","2025-03-18","2023-10-31","2023-08-22","2023-11-01","2023-09-25","2023-09-25","2023-09-25","2023-09-25","2023-09-25","2024-01-22","2024-07-16","2023-10-31","2023-10-27","2023-10-27","2023-12-11","2023-12-11","2023-12-11","2024-01-11","2024-01-11","2024-01-11","2024-01-24","2025-03-12","2024-01-22","2024-01-22","2024-01-22","2024-01-22","2024-01-23","2024-01-23","2024-01-23","2024-02-19","2024-01-24","2024-01-29","2024-01-24","2026-02-18","2024-02-21","2025-07-16","2024-04-23","2025-07-14","2025-12-12","2024-05-23","2025-07-14","2026-01-30","2025-12-17","2026-02-18","2023-03-29","2026-01-21","2025-12-12","2025-12-12","2025-09-30","2025-10-22","2024-08-20","2025-12-17","2025-09-19","2025-07-16","2026-01-30","2023-03-30","2026-02-18","2025-10-29","2024-09-03","2025-03-12","2025-06-26","2025-02-03","2025-04-14","2024-11-04","2025-01-06","2023-02-25","2023-02-26","2023-02-26","2023-03-07","2023-02-25","2023-03-17","2023-03-17","2023-03-07","2023-03-07","2023-03-06","2023-02-28","2023-03-06","2023-02-28","2023-02-28","2023-03-06","2023-03-03","2023-02-28","2023-02-28","2023-02-28","2023-02-27","2023-03-06","2023-02-26","2023-02-26","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31"],"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":[["","","VENCLEXTA","","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","TADALAFIL","20 MG","","Select","Select",""],["","","CLINDAMYCIN","300 MG","","Select","Select",""],["","","DICYCLOMINE","10 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","IBUPROFEN","600 MG","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","VALACYCLOVIR","1 GM","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","ALBUTEROL (","0.083%) 2.5","","Select","Select",""],["","","CHLORHEXIDINE","0.0012","","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":""}]}]}