{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan R Myers","gend":1,"currentgend":"","add":"164 FOWLER RD","city":"Cape Elizabeth","state":"ME","zip":"04107","dob":"1949-03-04","age":"","mstatus":"","insh":"10000035156","cliId":"","pno":"2077545643","cno":"2075360862","email":"susanripleymyers@gmail.com","ename":"","eno":"","pphy":"HEARD CUSHING, KAREN S","ppno":"2077745816","pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"164 FOWLER RD","madd2":"","madd3":"","mcity":"Cape Elizabeth","mstate":"ME","mzip":"04107","pcpfaxno":"2075238597","pcpnpi":"1720421217","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6WQ2AJ6HT25","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H02841","H00031","H0100A","H0100B","H0011","E7800","R7303","Z0001","Z23","M419","M5450","Z1231","J479","K5900","K449","R1013","Z98890","M5136","M47817","M5135","M4185","M47816","M4804","R051","J471","M67972","M19072","M2142","M792","H5203","H43813","L409","L501","R6889","R252","M8588","M810","M24872","K529"],"date":["2023-06-13","2023-10-19","2023-10-19","2023-10-19","2023-10-19","2023-10-23","2024-04-08","2023-10-23","2023-10-23","2024-02-13","2024-03-26","2024-04-23","2023-10-24","2023-09-27","2023-09-27","2023-09-27","2023-09-27","2024-02-13","2024-02-13","2023-11-06","2023-11-06","2024-05-08","2023-11-20","2023-12-11","2023-12-11","2024-05-09","2024-05-09","2024-04-05","2024-04-05","2024-01-29","2024-01-29","2024-02-19","2024-02-19","2023-05-01","2024-04-08","2024-04-23","2024-05-08","2024-05-09","2024-07-09"],"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",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Sod Sulf\/Pot Sulf\/Mag Sulf","17.5\/3.13\/1.6 G","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Rosuvastatin","10 MG","","Select","Select",""],["","","Paxlovid (Moderate Renal) Pack","","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Clobetasol 0.05 % Cream Xiromed","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","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":""}]}]}