{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anne M Chase","gend":1,"currentgend":"","add":"24 MEADOW HILL DR","city":"FARMINGDALE","state":"ME","zip":"04344","dob":"1949-03-25","age":"","mstatus":"","insh":"10000059998","cliId":"","pno":"2076234608","cno":"2072338900","email":"groycec@me.com","ename":"","eno":"","pphy":"HOKE, ABIGAIL","ppno":"2075826608","pcpadd":"Gardiner Family Medicine,5 Central Maine Crossing","pcpcity":"Gardiner","pcpstate":"ME","pcpzip":"04345","pcpcounty":"","pcpid":"","pcpname":"GARDINER FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 MEADOW HILL DR","madd2":"","madd3":"","mcity":"FARMINGDALE","mstate":"ME","mzip":"04344","pcpfaxno":"2075822258","pcpnpi":"1740576495","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1F20WY9KH27","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K5090","G40009","K56600","Z9049","Z0000","F331","G40909","F418","Z1231","R490","R296","Z9181","K5000","R110","K56609","D225","L814","L649","Z0100","D3132","G3184","R9401","R4189","G300","F0280","M9903","M47816","M9902","M47814","Z98890","I700","S3991XA","R109","R918","R1084","K50012","J189","G309","R197","R2689","Z09","K0889","R2681","R112","I10","W108XXS","G301","F02A3","F01A3","Z8719","G4733","Z789","R9431","K5641","K5900","E860","Z1152","Z043","R262","N390","G40209","S0990XA","W108XXA","R92323","M25562","I673","F0154","G43109","Z9089","Z90710","Z4802","Z0001","E876","E162","L03116","I493","S0101XA","M542","Z79899","R9089","G9389","G319","G40919","R4182","G4089","R1110","M25462","M25511"],"date":["2025-11-05","2026-02-26","2023-05-17","2025-01-23","2023-05-30","2023-05-30","2026-01-12","2023-05-30","2025-11-12","2023-10-13","2025-12-10","2023-08-29","2025-03-28","2025-05-13","2025-01-23","2023-10-30","2023-10-30","2023-10-30","2025-01-20","2025-01-20","2024-01-26","2024-01-22","2024-02-05","2025-11-04","2026-02-26","2024-09-17","2024-09-17","2024-09-17","2024-09-17","2024-04-26","2025-05-05","2024-04-29","2025-05-05","2024-04-27","2024-04-26","2025-02-26","2024-04-30","2026-02-26","2025-05-19","2025-10-09","2024-05-03","2024-11-17","2025-12-10","2026-02-02","2026-01-12","2024-09-12","2025-07-22","2025-07-22","2025-07-22","2025-02-26","2025-03-14","2025-03-13","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2025-09-05","2025-08-19","2025-10-10","2024-09-23","2025-09-05","2025-09-05","2025-11-12","2024-12-31","2025-01-15","2025-01-15","2025-01-15","2025-05-05","2025-05-05","2025-09-19","2025-03-12","2025-05-13","2025-03-24","2024-12-31","2025-02-17","2025-09-05","2025-09-05","2025-11-05","2024-09-24","2024-09-24","2024-09-24","2026-01-20","2026-01-12","2026-01-12","2025-03-23","2024-12-31","2023-02-01"],"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":[["","","ONDANSETRON","4 MG","","Select","Select",""],["","","BRIVIACT","","","Select","Select",""],["","","DIVALPROEX","500 MG","","Select","Select",""],["","","SERTRALINE","100 MG","","Select","Select",""],["","","PENICILLIN VK","500 MG","","Select","Select",""],["","","Xiidra","","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","DONEPEZIL","10 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","RIVASTIGMINE","9.5 MG\/24","","Select","Select",""],["","","SIMVASTATIN","40 MG","","Select","Select",""],["","","Fluzone Quad 2023-2024","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ZYMFENTRA","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","PRAVASTATIN","40 MG","","Select","Select",""],["","","Memantine","5 MG","","Select","Select",""],["","","LACOSAMIDE","100 MG","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","FLUZONE 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":""}]}]}