{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christine L Cummings","gend":1,"currentgend":"","add":"104 PENOBSCOT AVE","city":"Howland","state":"ME","zip":"04448","dob":"1950-07-18","age":"","mstatus":"","insh":"10000077827","cliId":"","pno":"2072902374","cno":"","email":"CUMMINGS.1@HOTMAIL.COM","ename":"","eno":"","pphy":"ALESSI, CARL F","ppno":"2077943296","pcpadd":"Penobscot Valley Hospital,7 Transalpine Rd","pcpcity":"Belfast","pcpstate":"ME","pcpzip":"04915","pcpcounty":"","pcpid":"","pcpname":"PENOBSCOT VALLEY PRIMARY CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 21","madd2":"","madd3":"","mcity":"West Enfield","mstate":"ME","mzip":"04493","pcpfaxno":"2077948072","pcpnpi":"1144214271","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1GH5UR9PH71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1231","K219","I10","M5450","G4733","E669","R739","Z6841","Z86010","Z1211","D124","D125","Z0100","Z23","S82842D","S82842A","S82832D","F32A","S8262XD","M85852","S82845A","J069","M84473A","S82892D","Z98890","M7989","M65841","M79641","M1811","R0600","R059","R509","J309"],"date":["2025-09-30","2025-11-18","2025-12-10","2023-05-08","2026-02-20","2023-08-09","2023-08-09","2023-08-09","2023-09-13","2023-09-13","2023-09-13","2023-09-13","2025-05-05","2024-11-25","2025-04-14","2025-06-01","2025-06-25","2025-11-18","2025-05-12","2025-09-30","2025-02-24","2024-10-02","2025-02-24","2025-06-25","2025-06-25","2024-11-25","2025-01-22","2025-01-22","2025-01-22","2024-12-04","2024-10-02","2024-10-02","2023-02-02"],"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":[["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","Ciproflox\/Dexameth 0.3\/0.1 % Otic Susp Amn","","","Select","Select",""],["","","Ciproflox\/Dexameth 0.3\/0.1 % Otic Susp San","","","Select","Select",""],["","","DULOXETINE","30 MG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","LOSARTAN","100 MG","","Select","Select",""],["","","FLUTICASONE PROP\/SALMETEROL","100\/50 MCG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","Esomeprazole Mag","20 MG","","Select","Select",""],["","","MELOXICAM","7.5 MG","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","CIPROFLOX\/DEXAMETH","0.3\/0.1 %","","Select","Select",""],["","","PREVNAR","","","Select","Select",""],["","","SPIKEVAX","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}