{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna M Gaudet","gend":1,"currentgend":"","add":"21 VICTORIA LN","city":"WINDHAM","state":"ME","zip":"04062","dob":"1952-11-07","age":"","mstatus":"","insh":"10000070203","cliId":"","pno":"2078389002","cno":"","email":"agaudet1@maine.rr.com","ename":"","eno":"","pphy":"MICHAUD, KATHRYN","ppno":"2077998596","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"21 VICTORIA LN","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":"2077991730","pcpnpi":"1104353838","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1CH3P21JH71","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":["N390","R300","I480","I10","E782","E119","E7439","C50912","R0683","E1165","M65311","M65331","G5603","E0590","Z794","H26492","H02883","Z853","Z79811","C50919","Z1502","G4733","G5601","M65332","E785","G5602","E669","C50119","Z7901","R519","Z90710","E039","R350","M50320","M5412","N281","H5213","R0981","K219","H9190"],"date":["2023-04-11","2023-04-11","2023-10-27","2024-06-27","2024-01-31","2024-04-19","2023-04-11","2023-05-03","2023-05-05","2024-06-19","2023-08-29","2023-08-29","2023-07-26","2023-07-25","2024-05-29","2023-06-09","2023-06-09","2024-06-14","2024-06-26","2024-06-26","2023-06-20","2024-06-27","2023-08-29","2023-07-26","2024-06-10","2024-06-10","2024-06-10","2023-08-26","2023-11-27","2024-06-21","2024-01-04","2024-05-06","2024-05-28","2024-07-10","2024-07-10","2024-06-14","2024-06-20","2024-06-21","2024-06-21","2024-06-21"],"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":[["","","Amoxicillin\/Clav","500\/125 MG","","Select","Select",""],["","","Hydromorphone","2 MG","","Select","Select",""],["","","Lorazepam","1 MG","","Select","Select",""],["","","Gemtesa","","","Select","Select",""],["","","Azithromycin","500 MG","","Select","Select",""],["","","Mounjaro","","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Rosuvastatin","40 MG","","Select","Select",""],["","","Zolpidem","5 MG","","Select","Select",""],["","","Onetouch Ultra","","","Select","Select",""],["","","Budesonide","0.5 MG","","Select","Select",""],["","","Solifenacin","10 MG","","Select","Select",""],["","","Triazolam","0.125 MG","","Select","Select",""],["","","Novolog Flexpen","","","Select","Select",""],["","","Famotidine","20 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Meloxicam","7.5 MG","","Select","Select",""],["","","Dexcom G6 Sensor","","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Ultra-Fine (Ref 320109)","","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Metoprolol Succ","25 MG","","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":""}]}]}