{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anne E Carter","gend":1,"currentgend":"","add":"2 JACK WAY","city":"Bowdoinham","state":"ME","zip":"04008","dob":"1944-03-23","age":"","mstatus":"","insh":"10000046026","cliId":"","pno":"6039151532","cno":"","email":"declined@10282025.com","ename":"","eno":"","pphy":"MAHER, JEFFREY P","ppno":"2073736848","pcpadd":"Mid Coast Medical Group,22 Station Ave Ste 101","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2 JACK WAY","madd2":"","madd3":"","mcity":"Bowdoinham","mstate":"ME","mzip":"04008","pcpfaxno":"2077219808","pcpnpi":"1699886051","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1TM5UW8EM97","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R6889","Z0000","Z9181","G629","I10","R269","M25561","G4709","Z1231","M1711","M779","M25569","M170","R300","D126","M5432","Z01818","A000","I2510","G8918","I4430","Z471","Z96651","M25661","I4720","I441","I440","I080","I2720","F5101","Z8249","Z1211","Z86010","Z8719","K635","R220","K115","D124","N1831","I129","Z87891","Z0100"],"date":["2023-01-15","2024-05-13","2023-05-15","2023-05-22","2024-05-13","2023-05-22","2024-03-14","2023-05-22","2023-07-03","2023-12-20","2023-07-10","2023-09-13","2023-09-13","2023-11-06","2023-11-13","2023-11-13","2023-12-11","2023-12-22","2023-12-28","2023-12-18","2024-02-16","2024-03-14","2024-01-02","2024-03-14","2024-01-11","2024-01-11","2024-01-11","2024-01-11","2024-01-11","2024-01-17","2024-02-16","2024-04-05","2024-04-05","2024-04-05","2024-04-05","2024-04-18","2024-04-18","2024-04-05","2024-05-13","2024-05-13","2024-05-13","2024-06-11"],"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":[["","","Celecoxib","200 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Tobramycin\/Dex 0.3\/0.1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Terbinafine","250 MG","","Select","Select",""],["","","Mirtazapine","7.5 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Sandoz","","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Tizanidine","4 MG","","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":""}]}]}