{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elsie M Whitten","gend":1,"currentgend":"","add":"106 SMITHFIELD ROAD","city":"Belgrade","state":"ME","zip":"04917","dob":"1939-05-21","age":"","mstatus":"","insh":"10000032022","cliId":"","pno":"2074659869","cno":"","email":"","ename":"","eno":"","pphy":"MADDEN, AMY K","ppno":"2076261561","pcpadd":"PO BOX 274,","pcpcity":"BELGRADE","pcpstate":"ME","pcpzip":"04917","pcpcounty":"","pcpid":"","pcpname":"BELGRADE REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"106 SMITHFIELD ROAD","madd2":"","madd3":"","mcity":"Belgrade","mstate":"ME","mzip":"04917","pcpfaxno":"2074953353","pcpnpi":"1508975152","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4CR8T57HY51","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z950","I081","K219","I459","I454","R9431","R059","E039","J810","J811","G309","I10","F02B0","R2681","R32","D649","R0902","R001","Z20822","Z87891","D519","I110","R4182","R109","K5900","R1032","I7091","B351","R1010","R1084","R638","E611","Z8616","R5383","N390","R451","Z8709","U071","D638","G4700","R531","Z7409","A419","J189","I959","Z743","Z9981","R0602","F0390","R82998","M25552","Z8673","Z87440","R350","B370","I2699","S40811A","L299","F419","D509","R918","I444","R634","M6281","N3001","R079","E785","R0981","R062","J302","I509","Z0000","E860","J9811","R0689","R600","D508","I452","I4510","J9601","J849","R0600"],"date":["2026-01-15","2023-08-27","2023-08-30","2023-08-25","2023-08-25","2025-01-30","2025-06-04","2025-09-19","2023-09-01","2023-08-25","2026-01-06","2025-09-11","2023-08-26","2025-10-08","2023-08-22","2025-10-04","2026-01-02","2023-08-25","2023-08-25","2023-08-25","2023-08-30","2023-09-29","2026-01-03","2023-12-18","2025-09-30","2025-10-03","2025-10-25","2023-12-20","2023-12-18","2023-12-14","2023-12-14","2023-12-27","2023-12-27","2025-12-04","2025-11-19","2026-01-06","2024-02-08","2023-10-10","2023-10-10","2024-04-17","2026-01-03","2026-01-03","2026-01-01","2026-01-01","2026-01-03","2026-01-02","2026-01-02","2025-06-04","2025-10-07","2025-07-02","2025-04-09","2025-04-09","2024-11-18","2026-01-09","2025-02-05","2025-10-07","2025-02-26","2025-02-26","2025-02-26","2025-09-17","2026-01-01","2026-01-05","2025-12-04","2025-12-04","2025-10-04","2025-01-29","2024-09-11","2025-05-06","2025-06-12","2025-05-06","2025-05-06","2025-11-13","2026-01-03","2025-01-29","2026-01-01","2025-06-12","2025-11-19","2025-01-30","2025-01-30","2026-01-06","2026-01-06","2026-01-01"],"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":[["","","SERTRALINE","25 MG","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","FLUDROCORTISONE ACETATE","","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","MIRTAZAPINE","15 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","HALOPERIDOL","2 MG\/ML","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","MNEXSPIKE","","","Select","Select",""],["","","FLUDROCORTISONE","0.1 MG","","Select","Select",""],["","","METHENAMINE MANDELATE","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","METHENAMINE MAN","0.5 GM","","Select","Select",""],["","","LEVOTHYROXINE","75 MCG","","Select","Select",""],["","","HYOSCYAMINE","0.125 MG","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","OXYBUTYNIN","5 MG","","Select","Select",""],["","","LACTULOSE","10 GM\/15","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","METHENAMINE HIP","1 GM","","Select","Select",""],["","","HYDROXYZINE HCL","25 MG","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","LOSARTAN","25 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","CIPROFLOXACIN","250 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Northstar","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","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":""}]}]}