{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan L Maurice","gend":1,"currentgend":"","add":"392 CAPISIC ST","city":"PORTLAND","state":"ME","zip":"04102","dob":"1951-05-30","age":"","mstatus":"","insh":"10000071893","cliId":"","pno":"2074000090","cno":"","email":"slmaurice@hotmail.com","ename":"","eno":"","pphy":"FUCHS ERTMAN, DEBRA","ppno":"2077745816","pcpadd":"100 GANNETT DRIVE,SUITE C","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"392 CAPISIC ST","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04102","pcpfaxno":"2078741483","pcpnpi":"1730158403","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8M59N81DH39","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","E0590","R079","I10","Z0001","Z1231","H524","H43813","R6889","Z1211","K5730","Z86010","J449","E7800","Z23","J441","R0602","J439","R233","J310","H3540","Z5189","J45901","J45998","M25562","L570","D492","R0789","R911","I249","R000","H5203","Z961","R5383","R918","R0902","Z129","Z87891","Z122","J189","A419","J929","R932","J9611","B3322","I2510","J432","J9809","R051","Z8701","J479","J984","J9621","I214","I41","J069","B9689","U071","M7910","Z1339","L03114","Z03818","J029","R0609","Z1289","L814","I081","R0982","I288","I77810","E041","R9439"],"date":["2023-04-13","2024-03-05","2025-04-06","2025-12-08","2025-06-16","2025-11-04","2024-04-25","2023-04-20","2023-10-08","2023-05-17","2023-05-17","2023-05-17","2026-01-11","2025-12-08","2025-10-14","2026-01-11","2025-04-06","2025-12-16","2024-03-05","2024-04-25","2025-07-29","2024-06-01","2024-05-23","2024-05-23","2024-06-11","2025-06-19","2024-06-20","2025-04-06","2025-06-18","2025-02-11","2025-02-09","2025-07-29","2025-07-29","2024-11-26","2026-01-05","2025-04-06","2024-11-01","2025-04-16","2024-11-01","2025-06-02","2025-02-09","2025-12-16","2025-12-16","2025-11-14","2025-11-14","2025-12-08","2025-03-20","2025-03-20","2026-01-11","2025-03-05","2024-11-21","2025-02-12","2025-02-12","2025-02-12","2025-02-12","2023-03-19","2023-03-19","2026-01-11","2026-01-11","2025-04-24","2025-05-08","2024-11-26","2024-11-26","2024-10-24","2024-10-24","2024-06-20","2025-11-25","2024-11-26","2025-11-25","2025-11-25","2025-08-26","2025-11-18"],"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":[["","","METHIMAZOLE","5 MG","","Select","Select",""],["","","MONTELUKAST","10 MG","","Select","Select",""],["","","BUPROPION HCL","150 MG","","Select","Select",""],["","","COLCHICINE","0.6 MG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","ROSUVASTATIN","5 MG","","Select","Select",""],["","","BUSPIRONE","10 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","Ipratropium 0.03 % Nas Spray Amneal","","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","LODOCO","","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","ATORVASTATIN","20 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","IPRATROPIUM","0.0003","","Select","Select",""],["","","ALBUTEROL (","0.083%) 2.5","","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":""}]}]}