{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dam H Nguyen","gend":0,"currentgend":"","add":"34 JOSSLYN ST","city":"Portland","state":"ME","zip":"04102","dob":"1953-04-02","age":"","mstatus":"","insh":"10000060122","cliId":"","pno":"2077750723","cno":"","email":"","ename":"","eno":"","pphy":"MORA, JENNIFER D","ppno":"2076622911","pcpadd":"MMC Internal Medicine Clinic,22 Bramhall St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04102","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE AND PED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"34 JOSSLYN ST","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04102","pcpfaxno":"2073966006","pcpnpi":"1164651261","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2KU1H87JK32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N281","N289","N2889","H2513","H5201","H524","H52203","E119","H02831","H02834","Z0000","Z7984","I252","E785","R918","Z23","I2510","E7849","R310","Q6102","R0602","I25118","M25562","G8929","S80852A","M25512","R202","J449","M7542","M795","J432","F17200","R0600","I255","F17210","N200","Z0189","Z89511","M75112","M67814","M19012","Z0389","S43432D","D489","Z122","Z1211","R0609","Z1212","N400","R319"],"date":["2025-11-05","2023-05-15","2024-06-20","2023-06-27","2023-06-27","2023-06-27","2023-06-27","2025-09-18","2023-06-27","2023-06-27","2024-10-15","2023-07-26","2024-11-13","2024-08-28","2023-10-26","2025-10-21","2025-05-14","2024-05-07","2025-11-05","2025-07-02","2025-04-15","2025-11-26","2024-11-29","2024-11-29","2024-11-14","2024-09-18","2025-09-18","2025-12-22","2024-12-03","2024-11-14","2025-12-18","2025-12-18","2025-12-18","2025-11-26","2024-07-23","2025-11-05","2024-11-14","2025-10-30","2024-11-18","2024-11-18","2024-11-18","2024-11-14","2024-12-03","2025-12-17","2025-08-04","2025-10-24","2025-08-04","2024-07-16","2023-02-08","2023-01-18"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","ISOSORBIDE MONONITRATE","30 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","Hydrocortisone 2.5 % Cream Fougera","","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","Ammonium Lac 12 % Cream Taro","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","Anoro Ellipta","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","UMECLIDINIUM\/VILANTEROL","62.5\/25 MCG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","HYDROCORTISONE","0.025","","Select","Select",""],["","","AMMONIUM LAC","0.12","","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":""}]}]}