{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna L Gordon","gend":1,"currentgend":"","add":"31 CHURCH STREET","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1944-02-09","age":"","mstatus":"","insh":"10000045624","cliId":"","pno":"2078076028","cno":"","email":"DLGORDON207@GMAIL.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":"31 CHURCH STREET","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":"2078741483","pcpnpi":"1720067317","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8EA4K15ED91","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M818","G609","G40309","R269","M19019","F322","M7989","E7800","G40301","G40909","R4589","F341","M1990","Z23","I10","G8929","R197","N179","N3001","G9340","R110","J45909","G40409","R410","R531","R262","Z736","N3000","E785","D696","N1831","Z79899","F329","F3342","D1800","J449","R1030","M4317","M47817","M7918","F32A","Z6829","E6601","G9009","R600","M79605","L03116","L539","N393","N3941","M5450","G894","M5137","M47816","M5126","M5136","N3642","N3946","R4182","Z1211","N3281","R301","Z0000","R251","Z6836","Z0001","F332","L820","R0781","R609","N390","G20C","T50905A","R2242","G20A1","R5383","M19012","I129","K5909","R296","G253","Z111","R569","R253","M6281","I6782","R29898","G9341","I890","B354"],"date":["2025-10-22","2024-05-28","2025-10-22","2023-05-19","2023-06-02","2023-11-27","2025-01-02","2023-06-02","2023-06-02","2023-07-26","2023-06-09","2023-09-15","2023-06-09","2025-10-06","2025-09-04","2023-09-15","2023-08-14","2025-09-09","2023-07-28","2025-09-09","2023-08-11","2024-03-22","2026-01-28","2023-07-20","2024-03-14","2025-09-15","2023-07-27","2023-07-27","2023-08-18","2023-08-01","2023-08-04","2025-09-09","2023-07-26","2023-09-15","2023-08-24","2023-08-31","2023-09-02","2025-05-13","2024-03-14","2024-01-19","2023-10-10","2023-10-10","2024-10-31","2023-12-13","2025-02-12","2025-02-12","2024-01-24","2024-01-24","2024-03-22","2024-11-06","2025-05-13","2025-05-13","2024-02-09","2024-02-09","2024-03-14","2024-03-14","2024-03-22","2024-04-01","2024-03-22","2024-03-05","2024-11-06","2024-11-06","2025-11-03","2024-05-28","2024-10-31","2024-10-30","2025-05-29","2024-10-30","2025-05-13","2025-01-28","2025-09-11","2025-10-22","2025-10-22","2025-01-02","2025-09-30","2024-09-24","2024-06-28","2025-05-29","2024-12-04","2025-05-13","2025-09-10","2025-08-20","2025-09-04","2025-09-04","2025-09-15","2025-09-06","2025-09-06","2025-09-09","2025-02-17","2024-09-11"],"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":[["","","Clotrim\/Betameth Diprop 1\/0.05 % Cream Act","","","Select","Select",""],["","","LEVETIRACETAM","500 MG","","Select","Select",""],["","","PREDNISONE","50 MG","","Select","Select",""],["","","ATORVASTATIN","20 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","PREGABALIN","150 MG","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","LAMOTRIGINE","100 MG","","Select","Select",""],["","","LOSARTAN","100 MG","","Select","Select",""],["","","Clotrimazole 1 % Cream Taro","","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","CARBIDOPA\/LEVODOPA","10\/100 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","OXYBUTYNIN","5 MG","","Select","Select",""],["","","CITALOPRAM","20 MG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","DIVALPROEX","250 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","Losartan\/Hydrochlorothiazide","100\/12.5 MG","","Select","Select",""],["","","Hydrocodone\/Acetaminophen","5\/325 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","TORSEMIDE","10 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","DULOXETINE","30 MG","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","CLOTRIMAZOLE","0.01","","Select","Select",""],["","","PREVNAR","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","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":""}]}]}