{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Megan C Perry","gend":1,"currentgend":"","add":"190 OLD PENNELLVILLE RD","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1954-12-02","age":"","mstatus":"","insh":"10000073771","cliId":"","pno":"2077255400","cno":"2074094958","email":"wperry@myfairpoint.net","ename":"","eno":"","pphy":"HOWE, TIMOTHY R","ppno":"","pcpadd":"329 MAINE ST,SUITE D","pcpcity":"BRUNSWICK","pcpstate":"ME","pcpzip":"40113310","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"190 OLD PENNELLVILLE RD","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":"2077219345","pcpnpi":"1083776371","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2WE1T76EA32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","Z01818","A000","M1711","Z471","Z96651","G8918","K219","E785","H2513","H40013","H52223","H5213","H2511","I10","K439","M21751","M21071","M79671","S93612A","M25775","M71572","M21072","M79672","K432","Z87891","R109","B351","M792","M79674","M79675","H5000","H532","H5319","H3530","Z961","H2512","M25572","R2689","M6281","R6889","G40909","Z98890","G4700","L821","Z0000","R262","G40309","F321","G603","M8588","M8589","Z780","Z1231","L600","L03031","R350","B3731","Z23","F419","H35373","L718","H5711","G500","D1801","L814","H5713","R9089","I6782","G44009","T1590XA","Z03821","Z6379"],"date":["2024-05-24","2023-04-06","2023-05-03","2023-07-06","2023-05-03","2023-07-31","2023-05-02","2023-10-04","2023-10-04","2023-05-31","2024-03-04","2023-05-31","2023-05-31","2023-06-22","2024-03-25","2023-08-22","2024-05-06","2024-05-06","2024-05-06","2023-09-25","2023-09-25","2023-09-25","2023-07-20","2023-11-01","2023-12-29","2023-08-22","2023-08-22","2024-05-10","2024-05-10","2024-05-10","2024-05-10","2023-09-01","2023-09-01","2023-09-01","2023-09-01","2023-09-01","2024-03-04","2023-11-03","2023-11-03","2023-11-03","2023-09-05","2023-11-28","2023-10-04","2024-07-02","2024-02-12","2023-11-06","2023-11-06","2024-01-22","2024-07-02","2023-11-01","2023-11-27","2023-11-29","2023-11-29","2023-12-08","2023-12-19","2023-12-19","2023-12-31","2023-12-31","2024-01-08","2024-06-25","2024-03-04","2024-02-12","2024-04-07","2024-03-05","2024-02-12","2024-02-12","2024-04-08","2024-05-14","2024-04-07","2024-05-14","2024-05-30","2024-05-30","2024-07-02"],"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":[["","","Dilantin","","","Select","Select",""],["","","Mupirocin 2 % Ointment Teva","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Phenytoin","100 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Mirtazapine","15 MG","","Select","Select",""],["","","Citalopram","20 MG","","Select","Select",""],["","","Phenytoin Sodium Extended","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Ciprofloxacin 0.3 % Ophth Sol Leading Phar","","","Select","Select",""],["","","Sumatriptan","50 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","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":""}]}]}