{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pamela J Aucoin","gend":1,"currentgend":"","add":"10B STAVE MILL RD","city":"GRAY","state":"ME","zip":"04039","dob":"1954-12-25","age":"","mstatus":"","insh":"10000074429","cliId":"","pno":"2074235094","cno":"","email":"pam04039@gmail.com","ename":"","eno":"","pphy":"FITZSIMMONS, MELANIE P","ppno":"2078923233","pcpadd":"MMP Lakes Regional Primary Care,584 Roosevelt Trl","pcpcity":"Windham","pcpstate":"ME","pcpzip":"04062","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE AND PED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10B STAVE MILL RD","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":"2078930752","pcpnpi":"1700953015","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8W45KX8GQ84","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9901","M542","M9905","M5450","E039","I2510","Q245","E782","Z87891","Z0000","J449","F1010","J432","H401131","H401134","D122","Z86010","D124","K621","Z1211","H40051","H401120","Z961","K1379","Z720","H401111","Z1231","F411","F331","H16142","J441","R0600","R6889","H401133","J309","I77810","Z122","F1020","R5383"],"date":["2024-06-18","2024-06-18","2024-06-18","2024-06-18","2023-12-26","2024-04-23","2024-04-17","2024-04-17","2024-05-03","2024-04-30","2024-04-23","2023-04-28","2023-05-02","2024-05-21","2023-11-09","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2023-12-01","2023-12-01","2023-12-01","2024-01-02","2024-01-02","2024-04-03","2024-02-02","2024-02-09","2024-01-09","2024-02-06","2024-03-04","2024-02-09","2023-12-29","2024-03-19","2024-04-17","2024-07-11","2024-05-03","2024-04-23","2024-04-23"],"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":[["","","Triamcinolone Acet 0.1 % Dent Paste Taro","","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Lupin","","","Select","Select",""],["","","Timolol Mal (Twice Daily) 0.5 % Ophth Sol","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Atropine 1 % Ophth Sol Alcon","","","Select","Select",""],["","","Brimonidine 0.1 % Ophth Sol Sandoz","","","Select","Select",""],["","","Breo Ellipta","","","Select","Select",""],["","","Symbicort","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Levothyroxine","112 MCG","","Select","Select",""],["","","Atropine 1 % Ophth Sol Apotex","","","Select","Select",""],["","","Citalopram","20 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Difluprednate 0.05 % Ophth Emuls Sandoz","","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","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":""}]}]}