{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dianne M Bubar","gend":1,"currentgend":"","add":"21 WOOD STREET","city":"OLD TOWN","state":"ME","zip":"04468","dob":"1952-07-17","age":"","mstatus":"","insh":"10000074025","cliId":"","pno":"2078276242","cno":"2077457724","email":"dmbubar@hotmail.com","ename":"","eno":"","pphy":"COLLINS, AMANDA S","ppno":"2079412373","pcpadd":"EMMC Husson Family Medicine,302 Husson Ave Ste 2","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"21 WOOD STREET","madd2":"","madd3":"","mcity":"OLD TOWN","mstate":"ME","mzip":"04468","pcpfaxno":"2079418803","pcpnpi":"1881960458","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2FG3G90QK72","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R1013","N390","I10","K319","K219","J45909","K581","Z800","Z9049","R6881","K2100","R140","K5900","R197","B9681","E782","G43909","F331","K2970","K8590","K838","R109","Z5189","R300","K8689","M5114","M4724","M4727","M546","M5410","Z8719","M5414","M5117","M4726","K810","Z0000","F418","L309","M5416","R748","R1033","R634","Z1231","L2089","Z79899","J4520"],"date":["2024-06-25","2023-12-06","2023-05-14","2023-06-02","2024-03-06","2023-09-06","2023-06-08","2023-06-08","2024-01-20","2023-06-08","2023-06-02","2023-08-30","2023-09-01","2023-07-26","2023-09-01","2024-07-02","2023-09-06","2024-07-02","2023-11-05","2024-04-23","2024-04-04","2024-05-14","2023-12-20","2024-01-06","2024-01-11","2024-01-17","2024-01-17","2024-01-24","2024-01-17","2024-01-17","2024-01-20","2024-01-24","2024-01-24","2024-02-27","2024-04-04","2024-03-06","2024-03-27","2024-03-27","2024-05-09","2024-05-01","2024-06-05","2024-06-05","2024-06-21","2024-07-03","2024-07-02","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":[["","","Linzess","","","Select","Select",""],["","","Pravastatin","10 MG","","Select","Select",""],["","","Sucralfate","1 GM","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Clobetasol 0.05 % Shampoo Taro","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Amitriptyline","10 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Cyclosporine Pf 0.05 % Ophth Emuls Mylan","","","Select","Select",""],["","","Creon","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Xifaxan","","","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":""}]}]}