{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janelle Kitchen Siebert","gend":1,"currentgend":"","add":"342 CAPE JELLISON RD","city":"STOCKTON SPRINGS","state":"ME","zip":"04981","dob":"1953-08-28","age":"","mstatus":"","insh":"10000061341","cliId":"","pno":"2076694937","cno":"","email":"Jkitchensiebert@icloud.com","ename":"","eno":"","pphy":"MAMULA, MEGHAN R","ppno":"2079891567","pcpadd":"Brewer Medical Center,735 Wilson St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"BREWER MEDICAL CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"342 CAPE JELLISON RD","madd2":"","madd3":"","mcity":"STOCKTON SPRINGS","mstate":"ME","mzip":"04981","pcpfaxno":"2079470435","pcpnpi":"1457456733","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1QD8U55KX39","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R6889","H25812","Z961","J069","R058","I10","I361","I499","J449","J189","J479","J4540","L814","L821","D229","L280","M810","J42","J431","F17210","G3184","Z0000","R41841","Z20822","J440","Z87891","S22080D","J441","Z0101","H43813","R911","L570","R0609","I119","Z23","R000","I493","I2720","G3185","F0390","I081","G300","A419","R0602","R6883","J439","E8351","E611","I071","S22080A","Z711","L438","F0280","D485","R918","R059","H2512","H25012"],"date":["2023-11-13","2023-07-24","2023-04-03","2023-04-13","2024-05-07","2025-09-09","2025-09-09","2024-06-14","2026-02-10","2025-12-29","2026-01-15","2024-05-17","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2025-02-11","2023-07-18","2024-07-10","2023-08-29","2025-05-08","2026-02-10","2024-10-01","2024-04-01","2023-12-11","2024-07-30","2026-03-05","2026-01-15","2025-09-23","2025-09-23","2024-05-07","2024-05-08","2024-05-17","2024-07-10","2025-10-09","2024-11-01","2026-01-15","2025-09-09","2024-07-30","2024-07-30","2024-07-10","2025-11-11","2025-03-24","2025-06-16","2025-12-25","2024-10-30","2025-07-01","2025-07-01","2024-08-05","2026-02-12","2024-10-28","2025-04-18","2025-11-11","2025-04-18","2025-12-25","2025-12-25","2023-02-09","2023-02-09"],"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":[["","","Tacrolimus 0.1 % Ointment Padagis","","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Encube","","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","Ciprofloxacin 0.3 % Ophth Sol Sandoz","","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","ALBUTEROL\/IPRATROPIUM","3\/0.5 MG\/3","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","ROFLUMILAST","250 MCG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Micro Labs","","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","ALBUTEROL (","0.083%) 2.5","","Select","Select",""],["","","CIPROFLOXACIN","0.003","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","TACROLIMUS","0.001","","Select","Select",""],["","","PREVNAR","","","Select","Select",""],["","","KETOROLAC","0.005","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","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":""}]}]}