{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra J Poulin","gend":1,"currentgend":"","add":"55 BAKER RD","city":"FREEPORT","state":"ME","zip":"04032","dob":"1943-01-08","age":"","mstatus":"","insh":"10000070826","cliId":"","pno":"8502811323","cno":"","email":"","ename":"","eno":"","pphy":"KNIGHTON, BRIAN K","ppno":"2078653491","pcpadd":"42 MALLETT DRIVE,","pcpcity":"FREEPORT","pcpstate":"ME","pcpzip":"40326760","pcpcounty":"","pcpid":"","pcpname":"FREEPORT MEDICAL CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"55 BAKER RD","madd2":"","madd3":"","mcity":"FREEPORT","mstate":"ME","mzip":"04032","pcpfaxno":"","pcpnpi":"1700824000","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2K30AA7CF16","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z96653","S8981XA","M25561","M6281","G4709","E7849","Z0000","Z13820","M8580","Z780","R110","R1084","L719","R079","K8020","N200","L570","D492","L820","L538","L298","R58","L578","D1801","L821","L718","R630","R7989","M2550","M7910","C44612","C44519","N289","N179","N1830","D3501","H26492","H353134","Z961","D7589","E538","Z853","H5203","Z0101","H353221","S72141D","E041","Z4789","M25551","H353231","H43393","H35432","E039","S7221XA","K591","Z09","S72141A","F1090","S72001D","H35723","W19XXXA","S7221XD","I10","D509","I499","N1832","D440","S8991XA","R252","K219","H353211","J343","M79604","E785","D225","R4182","H353124","A000","E042","N189"],"date":["2025-06-04","2023-05-25","2023-07-24","2023-07-24","2024-08-01","2024-06-10","2023-05-31","2023-08-09","2023-08-09","2023-08-09","2023-09-21","2023-09-21","2026-01-29","2023-12-04","2023-12-04","2024-04-18","2026-01-29","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2026-01-29","2023-12-08","2023-12-04","2024-05-23","2023-12-04","2023-12-04","2023-12-29","2023-12-29","2024-01-09","2024-04-18","2024-04-18","2024-04-18","2024-03-19","2026-02-24","2024-03-19","2025-05-29","2025-05-29","2024-05-23","2025-05-19","2025-05-19","2025-09-24","2025-10-23","2026-02-10","2025-10-17","2025-10-17","2026-02-24","2026-02-24","2026-02-24","2025-09-11","2025-06-03","2025-06-18","2025-06-04","2025-06-05","2025-06-05","2025-06-04","2024-11-20","2025-06-04","2025-07-22","2025-08-15","2025-08-28","2025-06-03","2024-10-17","2025-10-16","2025-06-03","2024-10-17","2025-06-04","2025-09-10","2026-02-10","2025-08-28","2025-08-28","2026-01-29","2025-06-04","2025-05-19","2025-06-22","2025-09-11","2024-08-08"],"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":[["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","LISINOPRIL","5 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","Metronidazole 0.75 % Cream Fougera","","","Select","Select",""],["","","DAYVIGO","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","50 MG","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","DULOXETINE","20 MG","","Select","Select",""],["","","Sulfamethoxazole\/Trimethoprim","400\/80 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","ZOLPIDEM","5 MG","","Select","Select",""],["","","METRONIDAZOLE","0.0075","","Select","Select",""],["","","FLUAD QUAD","","","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":""}]}]}