{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dana R Pushard","gend":0,"currentgend":"","add":"205 SHAKER RD","city":"Gray","state":"ME","zip":"04039","dob":"1967-07-12","age":"","mstatus":"","insh":"10000042897","cliId":"","pno":"2072127821","cno":"","email":"drpx4@fairpoint.net","ename":"","eno":"","pphy":"SALKO, DAVID L","ppno":"2077986200","pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"205 SHAKER RD","madd2":"","madd3":"","mcity":"Gray","mstate":"ME","mzip":"04039","pcpfaxno":"2078741483","pcpnpi":"1659338879","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1KC6GY1YU84","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","S80861A","Z09","R9431","R609","I10","I2510","A6920","M25569","I517","R600","M549","M25552","E785","I5189","M5136","R52","M25559","M5137","Z96642","T84091A","Z23","Z01818","T8484XA","E1122","E1140","K3184","Z471","Z96649","R809","M48061","M5116","M4726","T84020A","E162","R590","N179","M069","I129","T84090A","Z98890","T8451XA","I214","D649","R509","K922","R591","R000","R160","R7989","I361","Z96641","F419","N1830","N1832","E876","M542","I5021","K7200","M4800","S32592A","M19041","S73004A","I429","M19042","M5127","M47817","M4317","M5450","B957","R102","Z96643","T847XXD","J811","J323","J320","I340","M5104","Z7689","A419","K760","Z4789","M25542","Z5189","R1310","E1142","T8450XA","K5730","R059","M25551","W19XXXA","R55","R1111","B351","R0609","F1290","S72002A","R109","S299XXA","R0781","S0990XA","M5124","M5134","D631","S32009A","R7401","Z1211","D124","Z860100","R079","Z043","S32502A","S32018A","S32028A","S32038A","Z0000","E118","Z6836","G629"],"date":["2025-11-11","2023-07-25","2023-08-21","2023-08-21","2023-12-27","2025-02-12","2025-11-11","2023-08-21","2023-08-25","2023-09-05","2024-10-06","2023-09-19","2025-07-01","2024-04-17","2023-10-09","2023-11-21","2025-02-12","2024-09-05","2023-12-27","2025-07-01","2024-03-11","2024-02-14","2024-07-18","2024-03-11","2025-04-01","2024-09-10","2024-03-11","2024-09-18","2024-09-06","2024-04-17","2025-11-26","2024-05-22","2024-05-22","2024-07-05","2025-07-01","2024-10-10","2025-07-03","2025-06-18","2025-04-01","2024-07-29","2024-08-14","2024-12-09","2024-10-14","2024-10-11","2024-10-07","2024-10-07","2024-10-07","2024-10-07","2024-10-08","2025-04-09","2024-10-08","2025-01-03","2025-03-05","2025-02-12","2025-04-01","2025-02-03","2025-10-30","2024-10-07","2024-10-07","2025-01-03","2025-07-15","2025-06-18","2024-07-04","2025-05-28","2025-06-18","2025-11-26","2025-11-26","2025-11-26","2025-11-12","2024-10-04","2025-07-15","2025-07-15","2025-03-11","2024-10-12","2024-10-15","2024-10-15","2025-03-10","2025-02-20","2024-10-28","2025-12-04","2025-12-03","2024-09-26","2025-06-18","2025-12-12","2025-12-12","2024-09-23","2024-09-23","2025-12-03","2024-09-23","2025-01-03","2025-07-01","2025-12-03","2025-12-03","2025-04-09","2025-04-21","2025-04-21","2025-07-16","2024-09-23","2025-07-01","2025-07-01","2025-07-01","2025-02-20","2025-02-20","2024-09-10","2025-07-16","2025-07-16","2025-04-28","2025-04-28","2025-04-28","2024-10-08","2025-10-30","2025-07-15","2025-07-15","2025-07-15","2025-07-15","2023-02-28","2023-02-28","2023-02-28","2023-02-13"],"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":[["","","Dexcom G6 Transmitter","","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","FREESTYLE LITE","","","Select","Select",""],["","","Bd Nano 2 Gen","","","Select","Select",""],["","","CEFADROXIL","500 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","FLUOXETINE","40 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","SERTRALINE","25 MG","","Select","Select",""],["","","BUPROPION HCL","150 MG","","Select","Select",""],["","","Embecta Nano 2Nd Gen (Ref 320550)","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","FLUCELVAX","","","Select","Select",""],["","","MNEXSPIKE","","","Select","Select",""],["","","VICTOZA PEN","","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","TRAZODONE","100 MG","","Select","Select",""],["","","DIAZEPAM","2 MG","","Select","Select",""],["","","HUMULIN N KWIKPEN","","","Select","Select",""],["","","Dexcom G6 Sensor","","","Select","Select",""],["","","CYCLOBENZAPRINE","10 MG","","Select","Select",""],["","","Clobetasol 0.05 % Cream Encube","","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","GABAPENTIN","600 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","Dexcom G7 Sensor","","","Select","Select",""],["","","Dexcom G7 Receiver (Ref Stk-At-012)","","","Select","Select",""],["","","FLUARIX","","","Select","Select",""],["","","FREESTYLE","","","Select","Select",""],["","","HUMULIN N","","","Select","Select",""],["","","NOVOLIN N FLEXPEN","","","Select","Select",""],["","","LISINOPRIL","30 MG","","Select","Select",""],["","","Novolin 70\/30","","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","DEXCOM G","7 RECEIVER","","Select","Select",""],["","","BD NANO","","","Select","Select",""],["","","CLOBETASOL","0.0005","","Select","Select",""],["","","EMBECTA NANO","2ND GEN","","Select","Select",""],["","","NOVOLIN","","","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":""}]}]}