{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jacqueline M Waterhouse","gend":1,"currentgend":"","add":"56 WILDERNESS DR","city":"MEDWAY","state":"ME","zip":"04460","dob":"1953-05-30","age":"","mstatus":"","insh":"10000060073","cliId":"","pno":"2077469410","cno":"","email":"jj.kayak@juno.com","ename":"","eno":"","pphy":"PARADIS, KENDRA M","ppno":"","pcpadd":"C\/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT,PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"56 WILDERNESS DR","madd2":"","madd3":"","mcity":"MEDWAY","mstate":"ME","mzip":"04460","pcpfaxno":"2077774397","pcpnpi":"1588012314","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5K49RH3CE46","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","I10","E785","K649","Z1211","E782","Z0101","R6889","Z0000","Z1231","Z780","H01134","H01135","R928","M810","R920","N1831","Z87898","R9439","E1122","D1801","L821","L814","L2089","G4700","F331","L309","I129","R079","T148XXA","R944","I4510","I2089","R931","Z9181"],"date":["2026-01-28","2026-02-26","2024-12-30","2023-08-01","2023-08-24","2023-11-16","2026-01-15","2023-12-15","2025-01-03","2025-03-03","2023-12-27","2024-01-04","2024-01-04","2024-08-07","2024-03-27","2024-08-07","2026-02-26","2026-02-26","2026-01-28","2025-07-08","2025-12-09","2025-12-09","2025-12-09","2025-12-09","2025-05-06","2025-05-06","2024-10-29","2026-02-26","2025-12-02","2025-05-13","2024-11-14","2025-11-06","2026-02-10","2026-02-10","2023-01-17"],"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":[["","","Triamcinolone Acet 0.1 % Cream Taro","","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","TOBRADEX","","","Select","Select",""],["","","Triamcinolone Acet 0.025 % Cream Macleods","","","Select","Select",""],["","","LISINOPRIL","30 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","MNEXSPIKE","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","BUPROPION HCL","150 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Encube","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Encube","","","Select","Select",""],["","","CLONIDINE","0.1 MG","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","Ketoconazole 2 % Cream Fougera","","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","Clobetasol 0.05 % Cream Taro","","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Accord","","","Select","Select",""],["","","ATENOLOL","25 MG","","Select","Select",""],["","","Triamcinolone Acet 0.025 % Cream G&W","","","Select","Select",""],["","","CLOBETASOL","0.0005","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.00025","","Select","Select",""],["","","TACROLIMUS","0.001","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","KETOCONAZOLE","0.02","","Select","Select",""],["","","PREVNAR","","","Select","Select",""],["","","MUPIROCIN","0.02","","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":""}]}]}