{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Andrea M Vachon","gend":1,"currentgend":"","add":"244 LISBON AT APT 229","city":"Lisbon","state":"ME","zip":"04250","dob":"1975-03-13","age":"","mstatus":"","insh":"10000055900","cliId":"","pno":"2072406683","cno":"","email":"Darrensmom2006@hotmail.com","ename":"","eno":"","pphy":"HJORTH, CHRISTOPHER P","ppno":"2073861800","pcpadd":"Mid Coast Hospital,123 Medical Ctr Dr","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"244 LISBON AT APT 229","madd2":"","madd3":"","mcity":"Lisbon","mstate":"ME","mzip":"04250","pcpfaxno":"","pcpnpi":"1225415482","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5AJ3T94YW12","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1142","Z794","M7062","N6001","M7542","R928","R921","M7061","Z0271","M5450","R252","G8929","S6991XA","M7602","E119","H6122","M5126","M48061","E109","H04123","E1140","M792","R262","M7918","M5136","S76312A","X58XXXA","S6701XA","K219","E785","E669","Z5189","F3181","G5603","M47816","Z1239","R5382","L738","D225","L814","L821","M533","M47817","R490","M7632","M5416","R0683"],"date":["2024-06-13","2024-06-04","2023-10-19","2023-05-03","2023-11-01","2024-07-10","2023-05-03","2023-05-30","2023-06-15","2023-09-05","2023-09-01","2024-03-06","2023-07-21","2024-03-28","2024-03-28","2023-08-11","2024-01-29","2023-08-15","2023-09-14","2023-09-28","2023-09-27","2023-10-30","2023-10-30","2023-09-25","2023-10-11","2023-10-19","2023-10-19","2023-07-21","2023-10-19","2023-10-19","2023-10-19","2023-11-11","2024-03-12","2024-01-04","2024-01-23","2024-01-03","2024-01-15","2024-01-12","2024-01-12","2024-01-12","2024-01-12","2024-03-06","2024-01-29","2024-03-28","2024-03-28","2024-06-04","2024-05-30"],"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":[["","","Rizatriptan","10 MG","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Pregabalin","150 MG","","Select","Select",""],["","","Penicillin Vk","500 MG","","Select","Select",""],["","","Lisinopril","5 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Xiidra","","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Ibuprofen","600 MG","","Select","Select",""],["","","Clotrimazole 1 % Cream Glenmark","","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Prednisone","50 MG","","Select","Select",""],["","","Novofine","32 G","","Select","Select",""],["","","Jardiance","","","Select","Select",""],["","","Bd Ultra-Fine Micro","","","Select","Select",""],["","","Cefpodoxime","200 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Lantus Solostar","","","Select","Select",""],["","","Bupropion Hcl","150 MG","","Select","Select",""],["","","Unifine Pentips","","","Select","Select",""],["","","Tresiba","","","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":""}]}]}