{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michelle E Thibedeau","gend":1,"currentgend":"","add":"106 MORSE RD","city":"PLYMOUTH","state":"ME","zip":"04969","dob":"1948-10-10","age":"","mstatus":"","insh":"10000052897","cliId":"","pno":"4752029842","cno":"","email":"mitchthib@aol.com","ename":"","eno":"","pphy":"SZYLVIAN, CHADWICK J","ppno":"2079073030","pcpadd":"C\/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT,PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"106 MORSE RD","madd2":"","madd3":"","mcity":"PLYMOUTH","mstate":"ME","mzip":"04969","pcpfaxno":"2079073031","pcpnpi":"1205279056","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3HY9DD3DH34","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E782","E1165","E1142","R600","Z7984","I10","I4821","E039","C50412","Z170","Z9013","Z79811","M25551","M1611","M5136","M5441","G8929","E119","E6601","Z0000","Z1211","Z0101","H524","I4891","I361","Z13820","Z853","Z08","M8580","Z9012","Z923","R6889"],"date":["2023-04-12","2025-06-10","2025-06-10","2023-04-18","2024-04-16","2026-03-06","2026-03-06","2023-04-12","2024-02-07","2023-05-23","2023-05-23","2023-05-23","2023-08-10","2023-08-10","2023-08-30","2023-11-07","2023-11-07","2025-05-28","2023-11-07","2024-11-12","2024-01-03","2025-05-28","2025-05-28","2023-12-13","2024-03-20","2024-04-30","2025-06-19","2025-06-19","2025-06-19","2025-06-19","2025-03-04","2023-01-18"],"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":[["","","XARELTO","","","Select","Select",""],["","","FREESTYLE LITE","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","AMLODIPINE","10 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","ANASTROZOLE","1 MG","","Select","Select",""],["","","LISINOPRIL","2.5 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","METOPROLOL SUCC","200 MG","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","SPIKEVAX","","","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":""}]}]}