{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary D Babson","gend":1,"currentgend":"","add":"232 COOMBS RD","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1951-05-06","age":"","mstatus":"","insh":"10000047674","cliId":"","pno":"2077255987","cno":"","email":"MDBABSON@GMAIL.COM","ename":"","eno":"","pphy":"MESERVE, CHRISTOPHER W","ppno":"2074067600","pcpadd":"Mid Coast Medical Group Topsham Internal Medicine,1 Wellness Way Ste A","pcpcity":"Topsham","pcpstate":"ME","pcpzip":"04086","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"232 COOMBS RD","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":"2074067601","pcpnpi":"1184713471","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6R59UA3HG19","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R059","R6889","R011","I77810","I5189","Z1231","M810","I4891","R928","R922","K649","K5900","R110","K642","L570","L821","D229","H353132","Z0101","Z1211","Z86010","K5730","K5792","D128","R933","R9389","K5790","I700","K5732","R590","N83202","K51312","R002","D729","E611","K51011","B029","K921","L719","I5030","R519","K5130","N83292","Z13228","Z13220","Z136","K56699","K529","K5150","K56600","R918","I517","Z4682","K219","R4182","R109","Z933","R079","K51311","I480","F32A","K6389","I2510","I7121","J479","D492","D2262","J90","M8580","E559","R5383","K5720","K6289","Z0000","K5650","K5651","M9901","M542","D7589","I719","R911","Z433","R1032","R5381","K51914","R61","K120","R9431","K047","K56609","A000","J449","F418","J9601","J189","I491","D72829","R140","M9900","M9902","M9903","M50322","J3801"],"date":["2023-04-23","2023-05-04","2023-05-08","2025-09-18","2023-05-08","2025-04-24","2023-05-16","2026-02-12","2023-06-15","2023-06-15","2023-07-17","2024-06-06","2023-07-01","2025-07-15","2025-08-20","2025-08-20","2025-08-20","2025-04-25","2025-09-12","2025-03-17","2023-09-22","2023-09-22","2025-04-14","2023-09-22","2023-11-10","2023-10-31","2023-10-23","2023-10-23","2025-12-17","2023-11-10","2024-04-22","2025-03-17","2023-11-24","2023-11-24","2023-11-24","2025-03-28","2023-12-20","2024-02-16","2024-04-30","2024-05-08","2024-05-14","2025-08-15","2024-06-06","2024-06-26","2024-06-26","2024-06-26","2025-01-09","2026-01-23","2025-03-17","2025-06-03","2025-12-19","2025-05-11","2025-05-11","2025-03-17","2025-03-17","2024-11-01","2025-12-17","2024-11-03","2025-03-14","2025-03-14","2025-03-14","2025-05-07","2025-09-18","2025-09-18","2025-09-18","2025-08-20","2025-08-20","2025-05-13","2024-08-06","2024-08-06","2024-10-25","2024-11-18","2024-08-06","2025-06-10","2025-05-10","2025-05-07","2026-01-12","2026-01-12","2025-05-15","2025-12-19","2025-12-19","2024-11-23","2024-11-01","2024-11-01","2024-11-19","2024-10-28","2024-07-31","2025-05-08","2025-07-06","2025-05-10","2024-11-23","2024-11-19","2024-11-19","2025-05-14","2025-05-14","2025-05-14","2025-05-14","2025-05-08","2023-03-13","2023-03-13","2023-03-13","2023-02-03","2023-01-23"],"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":[["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","VALACYCLOVIR","1 GM","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","Metronidazole 0.75 % Cream Fougera","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MESALAMINE","0.375 GM","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","HYDROXYZINE HCL","10 MG","","Select","Select",""],["","","AMOXICILLIN","400 MG\/5","","Select","Select",""],["","","BUDESONIDE","9 MG","","Select","Select",""],["","","FLUBLOK","","","Select","Select",""],["","","METRONIDAZOLE","0.0075","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","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":""}]}]}