{ "version": "0.4", "data": [ { "t": "Demographics", "q": [ { "name": "Bonita J Kershaw", "gend": 1, "currentgend": "", "add": "78 WINDWARD POINTE DR", "city": "WELLS", "state": "ME", "zip": "04090", "dob": "1950-08-16", "age": "", "mstatus": "", "insh": "10000058115", "cliId": "", "pno": 6035485919, "cno": "", "email": "Bonnie.kershaw@yahoo.com", "ename": "", "eno": "", "pphy": "POLLARD, DOUGLAS C", "ppno": 2073513530, "pcpadd": "York Hospital Internal Medicine of York,12 Hospital Dr Ste B", "pcpcity": "York", "pcpstate": "ME", "pcpzip": "03909", "pcpcounty": "", "pcpid": "", "pcpname": "YORK HOSPITAL INTERNAL MEDICINE OF YORK", "plan": "Martin's Point", "program": "Medicare", "lob": "GA - 2026", "region": "", "aligned": "", "ano": "", "add2": "", "add3": "", "madd1": "78 WINDWARD POINTE DR", "madd2": "", "madd3": "", "mcity": "WELLS", "mstate": "ME", "mzip": "04090", "pcpfaxno": 2073513574, "pcpnpi": 1710969803, "currentgendcomment": "", "pphycomment": "", "uniqueid": "", "medicareid": "9DD2TT6VQ93", "medicaidid": "", "pcpFlag": "" }, { "a": { "indx": [ "1", "", "", "", "", "", "", "" ], "comment": [ "", "", "", "", "", "", "", "" ], "sub": [] } }, { "a": [] }, { "a": [] }, { "a": [] }, { "a": [] } ] }, { "t": "Previously Documented Conditions", "q": [ { "a": { "diag": [ "C3411", "E876", "R935", "Z510", "R112", "K828", "E8342", "C3490", "I639", "E785", "C3482", "C7951", "Z01810", "Z5111", "J690", "J449", "C3481", "R41841", "R509", "J9811", "I890", "M6281", "R911", "R918", "R1011", "K769", "Z85118", "J984", "C3431", "G5731", "J432", "J479", "I2510", "Z0000", "Z452", "K5900", "C3412", "Z9049", "E860", "K922", "K3189", "A09", "C773", "C792", "R930", "I6523", "I6502", "E870", "K6389", "N281", "N200", "C3492", "H04121", "I10", "E440", "C3401", "R110", "I679", "R531", "L821", "L578", "Z85820", "M7989", "Z85840", "R948", "R1084", "R229", "D509", "E8351", "L089", "F4320", "I69320", "Z9989", "C799", "C3491", "I499", "R791", "F419", "R109", "I700", "K910", "C7989", "M8458XA", "C801", "M4726", "Z853", "G629", "C6932", "H2511", "H524", "H5442A5", "S8411XA", "R590", "K429", "I2694", "G9389", "G930", "D34", "E042", "R1033", "R933", "M5416", "M5481", "R1110", "I6522", "R410", "K529", "K2970", "Z79891", "R079", "R222", "E7800", "C3480", "M5450", "D1803", "A084", "I69920", "I69354", "K8590", "M25551", "C7931", "E222", "I088", "K8689", "J939", "Z87891", "Z0101", "R0981", "L570", "G893", "Z471", "Z96643", "R0609", "K5730", "Z09", "R2241", "I672", "R946", "Z5112", "Z1231" ], "date": [ "2026-02-13", "2025-11-26", "2025-12-01", "2025-08-04", "2025-11-05", "2024-07-01", "2025-11-25", "2025-09-21", "2024-08-22", "2024-11-05", "2026-01-13", "2025-10-03", "2024-04-29", "2026-01-26", "2025-09-12", "2026-02-13", "2024-10-17", "2023-08-28", "2025-09-12", "2025-09-12", "2025-11-26", "2025-10-03", "2024-05-22", "2025-02-12", "2024-05-31", "2024-06-26", "2025-08-20", "2025-05-29", "2024-11-07", "2026-01-09", "2023-08-15", "2023-08-15", "2024-01-31", "2023-07-17", "2025-02-12", "2024-07-08", "2025-04-02", "2025-05-29", "2025-12-11", "2024-05-24", "2024-05-24", "2024-05-31", "2025-08-07", "2025-02-12", "2024-05-28", "2024-08-22", "2024-08-22", "2025-10-24", "2024-06-26", "2024-05-31", "2025-09-21", "2025-07-18", "2025-12-08", "2026-01-14", "2024-07-16", "2024-07-08", "2024-07-09", "2024-07-15", "2024-07-15", "2024-11-21", "2024-11-21", "2024-11-21", "2025-02-12", "2025-01-29", "2024-06-27", "2024-06-14", "2025-01-29", "2026-02-06", "2025-11-25", "2024-10-01", "2026-01-20", "2023-08-17", "2024-07-07", "2025-01-29", "2025-01-29", "2026-01-28", "2023-03-01", "2023-03-01", "2026-01-27", "2024-06-19", "2024-09-10", "2025-07-18", "2025-02-26", "2025-09-21", "2025-02-26", "2025-11-14", "2024-08-29", "2024-11-12", "2024-09-30", "2024-09-30", "2024-09-30", "2025-01-03", "2025-07-18", "2024-01-17", "2026-01-28", "2024-07-06", "2024-07-06", "2024-09-24", "2024-09-24", "2024-06-02", "2024-06-02", "2025-02-26", "2023-10-18", "2024-06-14", "2026-01-14", "2024-05-24", "2024-06-05", "2024-07-19", "2025-11-11", "2024-05-22", "2025-01-22", "2026-01-14", "2025-04-02", "2025-10-10", "2025-09-21", "2024-05-25", "2023-08-10", "2023-07-10", "2024-10-25", "2025-05-07", "2025-03-31", "2024-08-01", "2026-01-28", "2024-10-25", "2024-05-08", "2024-05-06", "2023-09-26", "2023-09-19", "2023-11-30", "2025-09-15", "2025-05-07", "2025-05-07", "2026-01-27", "2024-06-26", "2025-02-28", "2025-11-24", "2025-08-20", "2025-10-07", "2026-01-05", "2023-02-03" ], "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": [ [ "", "", "ATORVASTATIN", "80 MG", "", "Select", "Select", "" ], [ "", "", "HYDROCHLOROTHIAZIDE", "12.5 MG", "", "Select", "Select", "" ], [ "", "", "Comirnaty 2023-2024", "", "", "Select", "Select", "" ], [ "", "", "CLOPIDOGREL", "75 MG", "", "Select", "Select", "" ], [ "", "", "Chlorhexidine 0.12 % Oral Rinse Xttrium", "", "", "Select", "Select", "" ], [ "", "", "AMOXICILLIN", "500 MG", "", "Select", "Select", "" ], [ "", "", "Fluad Quad 2023-2024", "", "", "Select", "Select", "" ], [ "", "", "Fluzone High-Dose Quad 2023-24", "", "", "Select", "Select", "" ], [ "", "", "LABETALOL", "300 MG", "", "Select", "Select", "" ], [ "", "", "HALOPERIDOL", "0.5 MG", "", "Select", "Select", "" ], [ "", "", "OLANZAPINE", "5 MG", "", "Select", "Select", "" ], [ "", "", "OXYCODONE HCL", "5 MG", "", "Select", "Select", "" ], [ "", "", "ONDANSETRON", "8 MG", "", "Select", "Select", "" ], [ "", "", "LORAZEPAM", "0.5 MG", "", "Select", "Select", "" ], [ "", "", "AMOXICILLIN\/CLAV", "875\/125 MG", "", "Select", "Select", "" ], [ "", "", "DRONABINOL", "10 MG", "", "Select", "Select", "" ], [ "", "", "FLUAD", "", "", "Select", "Select", "" ], [ "", "", "ALENDRONATE", "35 MG", "", "Select", "Select", "" ], [ "", "", "COMIRNATY", "", "", "Select", "Select", "" ], [ "", "", "PANTOPRAZOLE", "40 MG", "", "Select", "Select", "" ], [ "", "", "CEPHALEXIN", "500 MG", "", "Select", "Select", "" ], [ "", "", "METOCLOPRAMIDE", "10 MG", "", "Select", "Select", "" ], [ "", "", "ELIQUIS", "", "", "Select", "Select", "" ], [ "", "", "GABAPENTIN", "300 MG", "", "Select", "Select", "" ], [ "", "", "AZITHROMYCIN", "250 MG", "", "Select", "Select", "" ], [ "", "", "LUMAKRAS", "", "", "Select", "Select", "" ], [ "", "", "PROCHLORPERAZINE", "10 MG", "", "Select", "Select", "" ], [ "", "", "OMEPRAZOLE", "20 MG", "", "Select", "Select", "" ], [ "", "", "PROMETHAZINE", "25 MG", "", "Select", "Select", "" ], [ "", "", "AMLODIPINE", "5 MG", "", "Select", "Select", "" ], [ "", "", "ROSUVASTATIN", "40 MG", "", "Select", "Select", "" ], [ "", "", "LISINOPRIL", "5 MG", "", "Select", "Select", "" ], [ "", "", "DEXAMETHASONE", "4 MG", "", "Select", "Select", "" ], [ "", "", "POTASSIUM CL", "20 MEQ", "", "Select", "Select", "" ], [ "", "", "Lidocaine\/Prilocaine 2.5\/2.5 % Cream Fouge", "", "", "Select", "Select", "" ], [ "", "", "FUROSEMIDE", "20 MG", "", "Select", "Select", "" ], [ "", "", "Metronidazole 0.75 % Gel Cosette", "", "", "Select", "Select", "" ], [ "", "", "DOXYCYCLINE MONOHYDRATE", "100 MG", "", "Select", "Select", "" ], [ "", "", "KRAZATI", "", "", "Select", "Select", "" ], [ "", "", "Morphine Conc", "100 MG", "", "Select", "Select", "" ], [ "", "", "Lorazepam Intensol", "", "", "Select", "Select", "" ], [ "", "", "Fentanyl", "12 MCG", "", "Select", "Select", "" ], [ "", "", "LIDOCAINE\/PRILOCAINE", "2.5\/2.5 %", "", "Select", "Select", "" ], [ "", "", "FLUZONE HIGH-DOSE QUAD", "", "", "Select", "Select", "" ], [ "", "", "FLUAD QUAD", "", "", "Select", "Select", "" ], [ "", "", "LABETALOL HCL", "", "", "Select", "Select", "" ], [ "", "", "CHLORHEXIDINE", "0.0012", "", "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": "" } ] } ] }