{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beverly A Swett","gend":1,"currentgend":"","add":"345 MAGUIRE RD","city":"Kennebunk","state":"ME","zip":"04043","dob":"1949-09-13","age":"","mstatus":"","insh":"10000035295","cliId":"","pno":"2079853943","cno":"","email":"declined@102925.com","ename":"","eno":"","pphy":"CUTONE, JENNIFER A","ppno":"2074673200","pcpadd":"Internal Medicine of Southern Maine,2 Independence Dr Ste B","pcpcity":"Kennebunk","pcpstate":"ME","pcpzip":"04043","pcpcounty":"","pcpid":"","pcpname":"INTERNAL MEDICINE OF SOUTHERN MAINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"345 MAGUIRE RD","madd2":"","madd3":"","mcity":"Kennebunk","mstate":"ME","mzip":"04043","pcpfaxno":"2074673207","pcpnpi":"1003879909","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3KH8WG6JW52","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","K5900","I10","F418","Z0000","E1165","E1121","E113213","E11319","L729","E785","E875","L02411","L8990","T8189XD","T8189XA","D509","E538","G2581","Z794","N1830","M726","S81801A","D519","L905","L910","S31819A","K219","I110","I5022","T8130XA","B359","S31819D","L89312","S31010A","S81819S","T8131XD","R52","S31819S","A000","T148XXD","B372","E118","H01001","Z4801","M5450","M25551","G8929","R531","M8600","G894","L89150","L02414","Z5189","Z961","E113412","E113211","M1611","F17210","D751","L98419","H52223","H524","E103313","E1122","G44229","D649","F17200","E11622","Z0101","E103391","E103392","L110","R21","L03114","Z4800","B9689","R7982","E113313"],"date":["2026-02-05","2023-04-17","2025-07-22","2023-11-07","2023-04-17","2026-03-10","2024-09-06","2025-06-23","2023-08-29","2023-07-24","2025-07-22","2023-08-02","2023-08-02","2025-06-26","2025-10-14","2025-10-06","2023-08-01","2023-08-01","2023-08-29","2026-03-10","2024-09-06","2025-09-04","2023-09-21","2026-01-30","2024-09-05","2024-03-19","2023-11-07","2023-11-07","2025-10-30","2025-07-09","2023-11-28","2023-11-28","2024-04-18","2024-01-29","2024-01-29","2023-12-29","2025-10-30","2024-02-20","2025-09-30","2025-04-10","2024-04-12","2024-04-12","2024-04-12","2024-06-14","2024-07-14","2025-09-30","2026-02-27","2025-09-30","2025-12-20","2025-12-20","2025-12-20","2025-12-20","2025-06-23","2025-10-14","2025-10-09","2025-07-01","2025-08-14","2025-07-31","2025-07-30","2025-07-22","2024-12-02","2025-09-02","2025-09-02","2025-09-02","2024-09-23","2024-09-23","2025-04-15","2025-01-21","2025-02-10","2025-05-20","2025-05-20","2025-05-20","2025-04-28","2025-03-03","2025-05-02","2025-03-10","2025-05-02","2025-05-02","2025-10-09"],"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":[["","","Bacitracin 500 Units\/Gm Ophth Oint Perrigo","","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Taro","","","Select","Select",""],["","","FREESTYLE LITE","","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","LOVASTATIN","20 MG","","Select","Select",""],["","","SERTRALINE","100 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Macleods","","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","Clobetasol 0.05 % Shampoo Padagis","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","Lantus Solostar","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","CYCLOBENZAPRINE","10 MG","","Select","Select",""],["","","LISINOPRIL\/HYDROCHLOROTHIAZIDE","20\/12.5 MG","","Select","Select",""],["","","Clotrimazole 1 % Cream Taro","","","Select","Select",""],["","","BD ULTRA-FINE","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Encube","","","Select","Select",""],["","","BASAGLAR KWIKPEN","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","LORAZEPAM","0.5 MG","","Select","Select",""],["","","Freestyle Libre 2 Reader (Ref 71953-01)","","","Select","Select",""],["","","Freestyle Libre 2 Sensor","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","Freestyle Libre 2 Plus Sensor","","","Select","Select",""],["","","KERENDIA","","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","Select","Select",""],["","","BACITRACIN","500 UNITS\/GM","","Select","Select",""],["","","CLOTRIMAZOLE","0.01","","Select","Select",""],["","","FREESTYLE LIBRE","2 PLUS","","Select","Select",""],["","","MUPIROCIN","0.02","","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":""}]}]}