{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anna D Kimball","gend":1,"currentgend":"","add":"29 SCHOOL STREET","city":"Lewiston","state":"ME","zip":"04240","dob":"1949-01-28","age":"","mstatus":"","insh":"10000041451","cliId":"","pno":"2075763295","cno":"2072401543","email":"dakinmaine@live.com","ename":"","eno":"","pphy":"FERGUSON, CAROLYN A","ppno":"","pcpadd":"\tCentral Maine Family Medicine,12 High St Ste 302","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"29 SCHOOL STREET","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":"4027292102","pcpnpi":"1942653415","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7UV1F72PQ17","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J449","Z5181","M810","C419","S78011A","Z87891","I10","E8801","R918","J188","J441","J189","R051","Z20822","R0689","Z743","R0602","Z0000","G5613","Z89611","G546","R2689","Z448","Z09","Z148","J310","R059"],"date":["2025-06-03","2023-04-14","2023-11-09","2023-08-10","2023-08-10","2024-10-25","2025-12-19","2024-09-06","2025-01-30","2023-12-04","2025-12-19","2025-01-30","2023-12-04","2023-12-04","2025-12-19","2025-12-19","2025-11-14","2024-05-16","2024-10-10","2024-12-20","2024-12-17","2024-12-17","2024-12-17","2025-06-03","2025-06-03","2025-06-03","2025-12-19"],"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":[["","","ALBUTEROL\/IPRATROPIUM","3\/0.5 MG\/3","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","AZITHROMYCIN","500 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","LEVOFLOXACIN","500 MG","","Select","Select",""],["","","PREVNAR","","","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":""}]}]}