{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ruth Legere","gend":1,"currentgend":"","add":"665 SACO ST LOT 208","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1939-07-12","age":"","mstatus":"","insh":"10000056226","cliId":"","pno":"2078317655","cno":"","email":"declined@08302021.com","ename":"","eno":"","pphy":"SILCO, MICHAELA O","ppno":"2072838800","pcpadd":"100 GANNETT DRIVE,SUITE C","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"665 SACO ST LOT 208","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":"2072869853","pcpnpi":"1114212149","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2T43F78PD75","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":["I4819","I5032","N1831","I10","J810","J811","I129","M9901","M9902","R0602","M62838","I6523","E1165","R42","I4891","I6522","R739","E782","E039","E1122","Z0001","E113293","E1142","K2970","K5130","H5203","E119","E11319","Z23","M9900","M9908","M542","M546","I130","J90","J449","R069","I480","I7143","S81812A","I080","L0390","S81802S","M7989","M79605","M898X6","M79662","M25572","R600","M25519","K5289","K635","Z0000","R0609","E7841","M7918","R059","R413","E559","J029","E875","I3139","I509","M5481","I25810","I2510","M4802","M50121","M4722","R918","K219","M47812","R519","K5120","I499","I083","I4820","B351","G8929","R0600","Z87891","R1030","T148XXA","Z794","R1310","E785","R4182","I5020","J441","J22","M5412","H6121","K921","R197","R051","R531","I088","I517","R931","E669","E213","R002","R040","Z1211","H04123","H35373","K6289","N289","D649"],"date":["2023-07-12","2025-05-20","2023-07-12","2025-05-20","2023-04-13","2023-04-13","2025-06-30","2023-12-15","2023-12-15","2025-12-17","2025-09-23","2025-10-23","2026-02-02","2025-06-04","2026-02-17","2024-01-24","2023-06-19","2025-08-08","2025-08-08","2025-08-08","2025-09-05","2023-07-19","2025-12-17","2023-07-17","2025-11-05","2025-09-17","2025-09-18","2025-09-17","2026-01-19","2023-12-15","2023-12-15","2025-01-05","2025-01-05","2026-02-17","2023-12-20","2023-12-20","2023-12-20","2025-01-07","2025-10-23","2024-01-28","2024-02-13","2024-02-14","2024-02-14","2025-06-30","2024-12-16","2024-06-01","2024-04-26","2024-12-16","2024-06-20","2024-12-16","2025-07-16","2025-07-16","2024-07-25","2025-01-28","2024-08-28","2025-01-05","2025-12-15","2024-10-23","2024-10-23","2026-02-17","2024-10-24","2025-01-20","2025-12-31","2026-01-13","2026-02-17","2025-11-14","2025-09-30","2025-08-25","2025-09-23","2023-04-01","2025-11-05","2025-09-30","2025-09-23","2025-09-23","2026-02-17","2024-12-12","2025-11-14","2025-09-18","2024-10-03","2025-12-15","2026-02-17","2025-06-30","2025-08-06","2025-12-17","2025-07-16","2025-07-16","2025-07-16","2025-04-02","2026-01-02","2026-01-02","2025-08-25","2025-09-05","2024-07-22","2025-06-11","2026-02-17","2025-12-15","2025-12-16","2025-12-16","2025-12-16","2023-03-20","2023-03-20","2026-02-17","2023-03-08","2023-03-16","2023-03-02","2023-03-02","2023-03-16","2023-03-16","2023-01-26"],"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":[["","","CAREONE UNIFINE PENTIPS PLUS SHORT","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","CYCLOBENZAPRINE","5 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","LEVOTHYROXINE","50 MCG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","LISINOPRIL","30 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","MESALAMINE","1 GM","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","236 GM","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","ONETOUCH VERIO","","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","Ultra-Fine (Ref 320109)","","","Select","Select",""],["","","GABAPENTIN","600 MG","","Select","Select",""],["","","TRAZODONE","100 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","FLUTICASONE FUR\/VILANTEROL","100\/25 MCG","","Select","Select",""],["","","NITROGLYCERIN","0.4 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","Tobramycin\/Dex 0.3\/0.1 % Ophth Susp B&L","","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","BASAGLAR KWIKPEN","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","B-D ULTRA-FINE SHORT","","","Select","Select",""],["","","ULTRA-FINE (REF","","","Select","Select",""],["","","TOBRAMYCIN\/DEX","0.3\/0.1 %","","Select","Select",""],["","","PEG","3350\/ELECTROLYTES 236","","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":""}]}]}