{ "version": "0.4", "data": [ { "t": "Demographics", "q": [ { "name": "Linda J Hussey", "gend": 1, "currentgend": "", "add": "232 HOOPER SANDS RD", "city": "SOUTH BERWICK", "state": "ME", "zip": "03908", "dob": "1955-08-06", "age": "", "mstatus": "", "insh": "10000078623", "cliId": "", "pno": 2073842598, "cno": "", "email": "mhcrazyhair@yahoo.com", "ename": "", "eno": "", "pphy": "LAUTER, M DAVID", "ppno": 6034337500, "pcpadd": "200 Griffin Rd Ste 11,", "pcpcity": "Portsmouth", "pcpstate": "NH", "pcpzip": "03801", "pcpcounty": "", "pcpid": "", "pcpname": "M DAVID LAUTER MD", "plan": "Martin's Point", "program": "Medicare", "lob": "GA - 2026", "region": "", "aligned": "", "ano": "", "add2": "", "add3": "", "madd1": "232 HOOPER SANDS RD", "madd2": "", "madd3": "", "mcity": "SOUTH BERWICK", "mstate": "ME", "mzip": "03908", "pcpfaxno": 6034337532, "pcpnpi": 1366544819, "currentgendcomment": "", "pphycomment": "", "uniqueid": "", "medicareid": "8CX6J77FQ49", "medicaidid": "", "pcpFlag": "" }, { "a": { "indx": [ "1", "", "", "", "", "", "", "" ], "comment": [ "", "", "", "", "", "", "", "" ], "sub": [] } }, { "a": [] }, { "a": [] }, { "a": [] }, { "a": [] } ] }, { "t": "Previously Documented Conditions", "q": [ { "a": { "diag": [ "K521", "Z510", "C538", "C7A8", "C539", "C7B8", "R1314", "T18120A", "E8342", "E876", "R197", "E11649", "I10", "J449", "I739", "N390", "C787", "C801", "Z471", "R0602", "N950", "N888", "D069", "Z5111", "R918", "E8351", "G5601", "D508", "I5020", "C7A1", "R6889", "R609", "C254", "D696", "I110", "R5381", "T18128A", "D704", "C7A090", "J9601", "G5621", "J90", "R0600", "J811", "J439", "C541", "B977", "Z0001", "E1169", "E782", "M9901", "M542", "C7A00", "N170", "E1165", "F411", "I429", "I70213", "Z0000", "E785", "M6281", "C7951", "R600", "Z4789", "M25512", "K769", "R911", "N858", "C778", "Z8541", "J441", "C530", "C771", "G43009", "Z48813", "R160", "M79643", "M75122", "M75112", "S43432A", "M7542", "R519", "I6782", "Z01810", "R112", "T451X5A", "C772", "Z8501", "C3490", "C7989", "Z743", "N889", "D251", "D250", "I8001", "S8011XA", "E11641", "D3A8", "E1151", "C579", "R5383", "R454", "R42" ], "date": [ "2025-10-06", "2025-10-10", "2025-10-13", "2026-02-10", "2026-01-20", "2026-02-06", "2025-09-01", "2025-09-01", "2025-12-16", "2025-10-20", "2026-02-12", "2025-11-13", "2025-09-18", "2026-02-04", "2024-11-19", "2026-01-16", "2026-01-09", "2025-12-21", "2023-08-08", "2025-12-21", "2025-04-09", "2025-02-14", "2025-07-14", "2025-09-12", "2025-12-19", "2025-10-10", "2024-10-18", "2025-05-06", "2025-03-29", "2025-06-24", "2023-09-15", "2026-01-29", "2026-02-04", "2025-12-22", "2025-03-27", "2025-12-10", "2025-09-01", "2025-12-22", "2025-06-24", "2025-03-29", "2024-10-02", "2025-03-27", "2025-03-27", "2025-03-27", "2025-03-27", "2025-05-06", "2025-02-14", "2024-10-01", "2026-01-14", "2024-07-23", "2024-12-12", "2024-12-12", "2025-11-13", "2025-10-14", "2025-04-09", "2025-04-09", "2025-09-04", "2024-10-01", "2025-09-26", "2025-10-10", "2026-02-04", "2026-02-04", "2025-09-24", "2024-10-18", "2024-09-19", "2025-08-05", "2025-08-05", "2025-09-25", "2025-05-21", "2025-09-29", "2025-08-06", "2025-08-06", "2025-05-08", "2025-04-11", "2025-06-24", "2025-04-04", "2024-08-20", "2023-05-03", "2023-05-03", "2023-05-03", "2023-05-03", "2025-04-11", "2025-04-11", "2023-05-02", "2025-08-30", "2025-08-30", "2025-08-31", "2025-08-31", "2025-03-31", "2025-03-29", "2025-03-29", "2025-07-29", "2025-04-13", "2025-04-13", "2026-01-14", "2026-01-14", "2025-12-31", "2026-01-09", "2025-01-06", "2025-05-06", "2024-05-14", "2024-05-14", "2024-07-23" ], "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": [ [ "", "", "ATORVASTATIN", "40 MG", "", "Select", "Select", "" ], [ "", "", "SULFAMETHOXAZOLE\/TRIMETHOPRIM", "800\/160 MG", "", "Select", "Select", "" ], [ "", "", "OXYCODONE HCL", "5 MG", "", "Select", "Select", "" ], [ "", "", "FLUCONAZOLE", "150 MG", "", "Select", "Select", "" ], [ "", "", "NITROFURANTOIN MACRO\/MONO", "100 MG", "", "Select", "Select", "" ], [ "", "", "CEPHALEXIN", "250 MG", "", "Select", "Select", "" ], [ "", "", "GLIPIZIDE", "10 MG", "", "Select", "Select", "" ], [ "", "", "Fluzone High-Dose Quad 2023-24", "", "", "Select", "Select", "" ], [ "", "", "METFORMIN", "500 MG", "", "Select", "Select", "" ], [ "", "", "ACCU-CHEK SOFTCLIX", "", "", "Select", "Select", "" ], [ "", "", "ACCU-CHEK GUIDE", "", "", "Select", "Select", "" ], [ "", "", "Bd Nano 2 Gen", "", "", "Select", "Select", "" ], [ "", "", "TRESIBA FLEXTOUCH", "", "", "Select", "Select", "" ], [ "", "", "FLUZONE HIGH-DOSE", "", "", "Select", "Select", "" ], [ "", "", "TRAMADOL", "50 MG", "", "Select", "Select", "" ], [ "", "", "IBUPROFEN", "600 MG", "", "Select", "Select", "" ], [ "", "", "ACCU-CHEK GUIDE ME", "", "", "Select", "Select", "" ], [ "", "", "Cholestyramine Light", "4 GM", "", "Select", "Select", "" ], [ "", "", "ALBUTEROL\/IPRATROPIUM", "3\/0.5 MG\/3", "", "Select", "Select", "" ], [ "", "", "FLUZONE HIGH DOSE", "", "", "Select", "Select", "" ], [ "", "", "METOPROLOL SUCC", "25 MG", "", "Select", "Select", "" ], [ "", "", "Rosuvastatin", "20 MG", "", "Select", "Select", "" ], [ "", "", "LOSARTAN", "25 MG", "", "Select", "Select", "" ], [ "", "", "DIPHENOX\/ATROPINE", "2.5\/0.025 MG", "", "Select", "Select", "" ], [ "", "", "Lidocaine Viscous 2 % Oral Top Sol Advagen", "", "", "Select", "Select", "" ], [ "", "", "TRELEGY ELLIPTA", "", "", "Select", "Select", "" ], [ "", "", "Silver Sulfadiazine 1 % Cream Ascend Labs", "", "", "Select", "Select", "" ], [ "", "", "SUMATRIPTAN", "50 MG", "", "Select", "Select", "" ], [ "", "", "SPIRONOLACTONE", "25 MG", "", "Select", "Select", "" ], [ "", "", "FUROSEMIDE", "40 MG", "", "Select", "Select", "" ], [ "", "", "Clotrimazole 1 % Cream Taro", "", "", "Select", "Select", "" ], [ "", "", "AMOXICILLIN\/CLAV", "875\/125 MG", "", "Select", "Select", "" ], [ "", "", "OPIUM TINCTURE", "", "", "Select", "Select", "" ], [ "", "", "Escitalopram", "5 MG", "", "Select", "Select", "" ], [ "", "", "ONDANSETRON", "8 MG", "", "Select", "Select", "" ], [ "", "", "PROCHLORPERAZINE", "10 MG", "", "Select", "Select", "" ], [ "", "", "CEFUROXIME", "250 MG", "", "Select", "Select", "" ], [ "", "", "CEFPODOXIME", "200 MG", "", "Select", "Select", "" ], [ "", "", "DEXAMETHASONE", "4 MG", "", "Select", "Select", "" ], [ "", "", "Nystatin 100", "", "", "Select", "Select", "" ], [ "", "", "FLUZONE HIGH-DOSE QUAD", "", "", "Select", "Select", "" ], [ "", "", "BD NANO", "", "", "Select", "Select", "" ], [ "", "", "CLOTRIMAZOLE", "0.01", "", "Select", "Select", "" ], [ "", "", "LIDOCAINE VISCOUS", "0.02", "", "Select", "Select", "" ], [ "", "", "SILVER SULFADIAZINE", "0.01", "", "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": "" } ] } ] }