{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lesley D Coburn","gend":1,"currentgend":"","add":"21 LAKE SHORE DR","city":"Greene","state":"ME","zip":"04236","dob":"1951-08-27","age":"","mstatus":"","insh":"10000031150","cliId":"","pno":"2075774628","cno":"","email":"LASS51@AOL.COM","ename":"","eno":"","pphy":"FAGONE, RENEE S","ppno":"2077955700","pcpadd":"12 HIGH ST,SUITE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407676","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2393985605","add2":"","add3":"","madd1":"21 LAKE SHORE DR","madd2":"","madd3":"","mcity":"Greene","mstate":"ME","mzip":"04236","pcpfaxno":"2077955727","pcpnpi":"1164653879","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5T01DG9RA38","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E042","E034","M1610","Z96641","R262","M1611","Z96649","M19012","M7542","Z0000","F419","E213","E7800","Z0101","H25811","H25812","H16223","G5610","G5613","G5602","G5601","E041","E039","Z1231","Z23","S60229A","R52","R3915","N393","N3642","M7541","F329","M25551","Z98890","M19031"],"date":["2023-04-24","2023-04-24","2023-05-01","2023-05-15","2023-05-15","2023-05-15","2023-06-14","2023-06-09","2024-05-28","2023-06-14","2023-06-14","2024-06-18","2024-07-05","2023-06-29","2023-06-29","2023-06-29","2023-06-29","2023-07-05","2023-07-05","2023-08-08","2023-10-06","2023-10-10","2023-10-10","2023-11-02","2023-12-14","2024-02-12","2024-02-12","2024-02-08","2024-02-08","2024-02-08","2024-05-28","2024-03-27","2024-04-16","2024-04-16","2024-05-20"],"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":[["","","Alprazolam","0.25 MG","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Levothyroxine","125 MCG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Allopurinol","100 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Azithromycin","500 MG","","Select","Select",""],["","","Meloxicam","15 MG","","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":""}]}]}