{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Denise B Coombs","gend":1,"currentgend":"","add":"21 RANGE RD","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1952-10-07","age":"","mstatus":"","insh":"10000060089","cliId":"","pno":"2075221928","cno":"","email":"COOMBSMD@COMCAST.NET","ename":"","eno":"","pphy":"RIEHL, JENNIFER M","ppno":"2074067600","pcpadd":"Mid Coast Medical Group Topsham Internal Medicine,1 Wellness Way Ste A","pcpcity":"Topsham","pcpstate":"ME","pcpzip":"04086","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"21 RANGE RD","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":"2074067601","pcpnpi":"1700897618","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1QF8GJ1FQ55","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R6889","K56609","R1032","K5790","N1831","N281","K6389","Z0000","I340","I081","H5203","H401221","H401222","J029","Z8616","T148XXA","L570","F5101","I10","S3992XA","M549","I700","M419","M47816","M5450","K429","S32029D","X509XXD","Z9181","S32020D","F411"],"date":["2023-11-23","2023-07-21","2023-06-06","2024-06-11","2024-07-02","2023-06-06","2023-06-06","2023-07-21","2024-03-11","2023-08-03","2023-09-21","2024-04-17","2023-12-20","2024-01-11","2024-01-11","2024-05-25","2024-05-23","2024-05-28","2024-06-17","2024-06-04","2024-06-04","2024-06-04","2024-06-04","2024-06-04","2024-06-11","2024-06-11","2024-06-17","2024-06-17","2024-07-02","2024-07-02","2024-07-02"],"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":[["","","Hydrocodone-Acetaminophen","","","Select","Select",""],["","","Metronidazole 0.75 % Gel Cosette","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Atenolol","50 MG","","Select","Select",""],["","","Alprazolam","0.5 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Metronidazole 0.75 % Cream Fougera","","","Select","Select",""],["","","Nortriptyline","50 MG","","Select","Select",""],["","","Levothyroxine","25 MCG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Hydrocodone\/Acetaminophen","7.5\/325 MG","","Select","Select",""],["","","Ofloxacin 0.3 % Ophth Sol Apotex","","","Select","Select",""],["","","Metoprolol Succ","100 MG","","Select","Select",""],["","","Metronidazole 0.75 % Cream Viona Pharmaceu","","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Duloxetine","30 MG","","Select","Select",""],["","","Cyclobenzaprine","10 MG","","Select","Select",""],["","","Nortriptyline Hcl","","","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":""}]}]}