{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gail E Seabury","gend":1,"currentgend":"","add":"362 E MAIN ST","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1950-11-22","age":"","mstatus":"","insh":"10000044472","cliId":"","pno":"2078464495","cno":"","email":"BFLOGAL@HOTMAIL.COM","ename":"","eno":"","pphy":"PATCH, JEFFREY S","ppno":"2078469013","pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"362 E MAIN ST","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":"2078741483","pcpnpi":"1720067317","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6YP4QH4AC61","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H8112","G35","R2689","R262","M6281","M810","R300","L298","L400","Z0000","E113293","H532","H5022","G4733","N390","E1142","H903","G9389","M4854XD","F330","H8113","H5213","H52223","E1136","R32","R8290","E039","Z20822","N319","R339","Z0101","L508","N312","Z23","R6889","Z1231","F4323","R2681","N898","E785","E1169","L570","L282","M25551","Z96641","G35A","S22050D","S12290D","S12100D","G35C0","G8220","R531","R5381","D692","L821","L720","Z515","M5450","G8929","E1165","R269","M2450","A419","Z743","E559","E538","M19012","R1110","T148XXA","E1121","G35D","L8942","Z98890","K7689","N281","R1032","R338","R079","A000","M533","M1612","M25512","H2513","H33303","Z9359","R490","R410","R112","M25552","S76212A","N3289","Z87891","G4730","Z435","Z960","M62838","F32A","S72001D","E871","E119","S12120D","S12101D","Z471","Z8781","S12200D","S060X0D","S12100S","M79651","M9903","M9904","M9905","M80851D","S12100A","S72009A","S7291XA","N3000","S12101A","E089","M80851A","S72001A","M80051D","G459","W19XXXA","E11610","R102","W1811XA"],"date":["2023-06-22","2025-09-28","2025-01-15","2023-08-28","2023-08-28","2024-08-06","2025-01-22","2023-12-14","2025-03-19","2025-09-26","2024-05-03","2023-07-12","2023-07-12","2023-07-18","2025-08-29","2023-05-24","2023-05-24","2023-06-16","2023-06-16","2023-06-27","2023-07-31","2023-07-12","2023-07-12","2025-11-03","2026-02-14","2024-07-11","2025-08-13","2023-05-03","2025-09-24","2025-09-24","2023-09-06","2023-09-23","2023-10-27","2025-12-01","2023-12-14","2024-01-22","2024-05-21","2024-06-26","2026-01-23","2025-08-13","2025-11-05","2024-06-17","2024-06-17","2025-10-22","2025-10-22","2026-03-06","2026-03-06","2026-03-06","2026-03-06","2026-03-05","2026-03-05","2025-06-16","2025-06-07","2025-03-19","2025-03-19","2025-03-19","2026-01-07","2026-01-07","2026-01-07","2026-02-28","2025-11-18","2025-12-10","2025-06-16","2025-06-16","2025-02-18","2025-02-18","2026-02-25","2025-06-08","2024-09-25","2025-11-05","2026-02-02","2025-11-05","2025-04-29","2025-06-08","2025-06-08","2025-03-31","2025-08-13","2025-06-08","2025-08-23","2025-07-24","2025-04-18","2026-03-05","2023-03-28","2023-03-28","2025-09-03","2025-09-03","2023-03-22","2025-06-09","2025-04-18","2025-04-18","2025-08-13","2025-08-13","2025-08-13","2025-08-14","2025-08-14","2025-06-19","2025-04-29","2023-03-29","2023-03-29","2025-04-21","2023-03-08","2023-03-17","2023-03-06","2023-03-16","2023-03-17","2023-03-17","2023-02-08","2023-02-07","2023-02-07","2023-02-07","2023-02-07","2023-01-31","2023-02-06","2023-02-08","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-27","2023-01-29","2023-02-03","2023-01-27","2023-01-27","2023-01-27","2023-01-27","2023-01-27"],"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":[["","","BUPRENORPHINE","15 MCG\/HR","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","Fluocinolone 0.01 % Otic Oil Rising","","","Select","Select",""],["","","Selenium Sulfide 2.5 % Lotion Padagis","","","Select","Select",""],["","","LEVOFLOXACIN","250 MG","","Select","Select",""],["","","CEPHALEXIN","250 MG","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ZOLPIDEM","10 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","SELENIUM SULFIDE","0.025","","Select","Select",""],["","","PRAVASTATIN","40 MG","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","FOSFOMYCIN","3 GM","","Select","Select",""],["","","BUPROPION HCL","150 MG","","Select","Select",""],["","","Mupirocin 2 % Ointment Glenmark","","","Select","Select",""],["","","Clobetasol 0.05 % Top Sol Micro Labs","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","ALPRAZOLAM","0.25 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","LEVOTHYROXINE","100 MCG","","Select","Select",""],["","","METHENAMINE HIP","1 GM","","Select","Select",""],["","","METHOCARBAMOL","500 MG","","Select","Select",""],["","","Calcipotriene 0.005 % Top Sol G&W","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","Clobetasol 0.05 % Top Sol Macleods","","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","Clobetasol 0.05 % Ointment Encube","","","Select","Select",""],["","","MOVANTIK","","","Select","Select",""],["","","Fluocinolone 0.01 % Top Sol Taro","","","Select","Select",""],["","","AUBAGIO","","","Select","Select",""],["","","CIPROFLOXACIN","250 MG","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","MORPHINE","15 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","CELECOXIB","100 MG","","Select","Select",""],["","","TIZANIDINE","2 MG","","Select","Select",""],["","","Hydrocortisone 2.5 % Ointment Fougera","","","Select","Select",""],["","","Xtampza Er","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","Fluocinolone 0.01 % Otic Oil Quagen","","","Select","Select",""],["","","Naloxone","4 MG","","Select","Select",""],["","","ALENDRONATE","70 MG","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","CALCIPOTRIENE","0.00005","","Select","Select",""],["","","FLUOCINOLONE","0.0001","","Select","Select",""],["","","CLOBETASOL","0.0005","","Select","Select",""],["","","MUPIROCIN","0.02","","Select","Select",""],["","","HYDROCORTISONE","0.025","","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":""}]}]}