{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan D Pascarella","gend":1,"currentgend":"","add":"117 WINDHAM CENTER RD","city":"WINDHAM","state":"ME","zip":"04062","dob":"1952-03-09","age":"","mstatus":"","insh":"10000054593","cliId":"","pno":"2073184994","cno":"","email":"sue.pasco@gmail.com","ename":"","eno":"","pphy":"LAVALLEE, HEATHER A","ppno":"","pcpadd":"100 FODEN ROAD,WEST BUILDING SUITE 103","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062351","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"117 WINDHAM CENTER RD","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":"2078280188","pcpnpi":"1841569720","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2TV8JF0PN35","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","G43809","G43109","G44209","F0781","S0990XA","C50412","Z170","M7918","Z0000","Z853","I4719","R921","Z08","I340","R059","Z0001","G43909","R0602","R110","M797","G8929","M5450","R251","R55","K7689","N200","N2889","N281","W19XXXA","I4891","I2699","R0600","L02211","I480","R000","I517","Z0389","I471","I10","Z7901","Z79899","R310","E6601","Z7689","R5383","E785","R92323","I081"],"date":["2026-01-22","2023-12-06","2024-06-24","2023-12-21","2023-12-21","2025-04-12","2026-01-19","2025-01-13","2023-10-17","2023-10-18","2026-01-15","2023-12-26","2025-02-14","2025-02-14","2024-04-26","2024-05-09","2024-10-22","2025-07-22","2024-12-15","2024-12-15","2025-09-04","2025-09-04","2025-09-04","2025-09-04","2025-04-12","2025-09-30","2025-09-30","2025-09-30","2025-09-30","2025-04-12","2025-12-09","2025-01-13","2024-12-15","2024-10-15","2025-06-09","2024-12-15","2024-12-15","2024-12-16","2023-03-24","2025-12-09","2025-06-09","2025-06-09","2025-09-29","2025-12-09","2025-01-07","2024-09-25","2025-12-09","2025-02-14","2025-08-12"],"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":[["","","Eliquis Starter Pack","","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","NURTEC ODT","","","Select","Select",""],["","","AMITRIPTYLINE","25 MG","","Select","Select",""],["","","DILTIAZEM","120 MG","","Select","Select",""],["","","PREGABALIN","50 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","CEFUROXIME","500 MG","","Select","Select",""],["","","AMIODARONE","200 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","ACETAZOLAMIDE","500 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","SUMATRIPTAN","100 MG","","Select","Select",""],["","","Duloxetine","20 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","CELECOXIB","200 MG","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","Clotrimazole 1 % Cream Taro","","","Select","Select",""],["","","UBRELVY","","","Select","Select",""],["","","ACETAZOLAMIDE ER","","","Select","Select",""],["","","QULIPTA","","","Select","Select",""],["","","Breo Ellipta","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CLOTRIMAZOLE","0.01","","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":""}]}]}