{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna L Dodge","gend":1,"currentgend":"","add":"81 SMITH ST UNIT 8","city":"Augusta","state":"ME","zip":"04330","dob":"1947-05-06","age":"","mstatus":"","insh":"10000032663","cliId":"","pno":"2074418747","cno":"","email":"donnadodge2@gmail.com","ename":"","eno":"","pphy":"SCHIFF SLATER, SCOTT D","ppno":"2076260606","pcpadd":"Hallowell Family Practice,\t9 Union St","pcpcity":"Hallowell","pcpstate":"ME","pcpzip":"04347","pcpcounty":"","pcpid":"","pcpname":"HALLOWELL FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"81 SMITH ST UNIT 8","madd2":"","madd3":"","mcity":"Augusta","mstate":"ME","mzip":"04330","pcpfaxno":"2076260022","pcpnpi":"1750354957","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8Y02KD6UW96","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J9611","J8489","M3481","I2723","R053","L820","I2729","E039","E785","Z23","K5909","R319","R151","R32","K5900","R300","H903","Z974","M810","M3489","Z79899","L940","I517","J849","N281","H15112","N200","I2720","I088","N952","N393","N3642","R159","Z0100","R350","Z1283","L570","L821","Z0001","K219","M349","M79642","I7300","N760","M25542","R6889","N390","R945","Z1211","K5520","I77810","I774","I8393","J8410","M2041","M79674","E559","I361","Z87891","Z860101","B349","R69","L97511","Z0000","M8589","M13142","F29","R061","R4702","I959","I7121","R0602","R785","H6121","K2090","R1310"],"date":["2026-02-04","2023-04-12","2025-09-03","2025-12-19","2023-10-25","2025-09-15","2023-06-07","2025-04-22","2025-04-22","2025-10-02","2023-10-19","2023-06-12","2023-10-19","2023-08-01","2023-07-17","2023-06-21","2023-06-07","2023-06-07","2025-09-25","2025-09-25","2025-09-25","2025-04-22","2023-07-17","2023-07-17","2023-08-01","2023-08-17","2023-08-01","2023-07-13","2023-07-13","2023-09-13","2023-11-09","2023-11-09","2023-09-21","2025-09-26","2023-09-27","2025-09-15","2023-09-28","2023-09-28","2025-05-06","2024-11-19","2024-10-31","2024-01-22","2024-01-09","2024-01-09","2024-01-10","2023-12-28","2024-01-09","2024-05-22","2024-07-11","2024-07-11","2025-10-21","2026-01-09","2026-01-09","2025-11-04","2026-02-03","2026-02-03","2024-10-31","2025-10-21","2024-11-19","2024-11-19","2023-03-28","2023-03-28","2025-12-02","2025-12-04","2024-08-09","2025-09-03","2025-11-04","2025-11-04","2025-11-04","2025-11-04","2024-10-07","2026-02-04","2025-09-03","2025-09-15","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":[["","","LINZESS","","","Select","Select",""],["","","DULOXETINE","30 MG","","Select","Select",""],["","","PRAZOSIN","1 MG","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","LEVOTHYROXINE","112 MCG","","Select","Select",""],["","","PREDNISONE","5 MG","","Select","Select",""],["","","PROLIA","","","Select","Select",""],["","","SILDENAFIL","20 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","NIFEDIPINE","30 MG","","Select","Select",""],["","","Jascayd","","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","OFEV","","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","ATORVASTATIN","20 MG","","Select","Select",""],["","","Clobetasol 0.05 % Ointment Encube","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CLOBETASOL","0.0005","","Select","Select",""],["","","ESTRADIOL","0.0001","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","COMIRNATY","","","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":""}]}]}