{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia K Powers","gend":1,"currentgend":"","add":"63 HAWTHORN COURT","city":"Cumberland","state":"ME","zip":"04021","dob":"1928-11-19","age":"","mstatus":"","insh":"10000052245","cliId":"","pno":"2078293881","cno":"","email":"declined@1192026.com","ename":"","eno":"","pphy":"PIERCE, DANIEL C","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":"63 HAWTHORN COURT","madd2":"","madd3":"","mcity":"Cumberland","mstate":"ME","mzip":"04021","pcpfaxno":"2078741483","pcpnpi":"1861451080","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2R77MP6GQ67","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N949","R32","T83711S","R300","H18513","H16223","H401131","G5601","E785","N1831","D649","N644","L299","H6121","Z0000","N393","T83711D","N952","N8189","H18512","H18232","Z23","K6289","I129","H259","N898","I10","R7303","T83711A","H5710","T1590XA","L0390","H18233","R399","H906","R309","S0081XA","S60416A","R8290","R531","S199XXA","S0990XA","N3941","M8588","M19072","R3915","M79675","M79672","Z98890","R600","M8580","N760","R1030","Z0001","Z4789","R102","M720","M19041","Z130","R42","R0789","R079","N763","N907"],"date":["2025-08-14","2025-02-07","2023-04-29","2024-06-26","2024-04-11","2024-04-11","2025-11-04","2025-05-07","2025-07-01","2024-06-21","2024-06-21","2025-02-26","2023-06-26","2023-06-26","2025-02-25","2023-07-14","2024-01-23","2024-01-23","2023-07-14","2023-09-12","2023-09-12","2025-10-10","2023-10-13","2025-07-01","2023-09-12","2023-12-04","2025-08-14","2025-07-01","2024-01-02","2024-04-04","2024-04-04","2024-04-04","2024-04-11","2024-05-18","2024-06-14","2024-06-26","2025-12-26","2025-12-26","2024-10-24","2025-12-26","2025-12-26","2025-12-26","2025-02-07","2025-01-24","2025-10-10","2025-08-14","2026-02-04","2025-11-05","2025-11-04","2025-01-07","2025-02-26","2025-05-15","2024-07-27","2025-07-08","2026-02-11","2025-05-15","2025-05-07","2025-05-07","2025-07-01","2025-12-26","2023-03-02","2023-03-02","2023-03-02","2023-03-02"],"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":[["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","Metronidazole 0.75 % Vag Gel Solaris","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","METOPROLOL TART","50 MG","","Select","Select",""],["","","ROSUVASTATIN","10 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Losartan","100 MG","","Select","Select",""],["","","Clindamycin 2 % Vag Cream Greenstone","","","Select","Select",""],["","","FAMOTIDINE","40 MG","","Select","Select",""],["","","CLINDAMYCIN","0.02","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","Fluorometholone 0.1 % Ophth Susp Pacific","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Somerset","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Sandoz","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","Betamethasone Diprop 0.05 % Ointment Padag","","","Select","Select",""],["","","ESTRING","","","Select","Select",""],["","","Fluorometholone 0.1 % Ophth Susp Amneal","","","Select","Select",""],["","","Dorzolamide\/Timolol 2\/0.5 % Ophth Sol B&L","","","Select","Select",""],["","","Polymyx\/Trimethoprim 10","","","Select","Select",""],["","","ESTRADIOL","0.0001","","Select","Select",""],["","","METRONIDAZOLE","0.0075","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","FLUOROMETHOLONE","0.001","","Select","Select",""],["","","LATANOPROST","0.00005","","Select","Select",""],["","","POLYMYX\/TRIMETHOPRIM","","","Select","Select",""],["","","BETAMETHASONE DIPROP","0.0005","","Select","Select",""],["","","DORZOLAMIDE\/TIMOLOL","2\/0.5 %","","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":""}]}]}