{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gillian M Woodcock","gend":1,"currentgend":"","add":"640 OCEAN AVE APT 217","city":"PORTLAND","state":"ME","zip":"04103","dob":"1935-07-12","age":"","mstatus":"","insh":"10000080020","cliId":"","pno":"2078051772","cno":"5183308018","email":"swoodcoc@nycap.rr.com","ename":"","eno":"","pphy":"BANKOFF, NATHAN","ppno":"2078741489","pcpadd":"InterMed,100 Foden Rd Ste 203","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"640 OCEAN AVE APT 217","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":"2075238590","pcpnpi":"1295267094","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4FX3MY8TJ13","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1612","I4891","I10","Z0000","Z23","R922","C50412","M25552","M810","Z170","Z96651","M25561","M1712","Z85828","L578","L820","L814","Z01818","I480","E871","Z96642","S72002A","Z7901","Z471","Z98890","D649","K219","J811","J90","R0902","I517","Z96643","D6489","E222","I499","H26493","H40013","H353131","H3562","Z136","I088","I340","M7989","Z09","L570","L853","R5383","S32009A","M5417","S32020D","K449","K5730","K5900","R1032","M5410","R262","Z736","I081","Q2112","Z853","I083","I288","M4856XA","M4856XD","S32028D","R7982","M8088XD","N390","Z7722","S32009D","Z8781","R921","M5481","Z4789","M5431","Z9189","R10A2","M5416","M5126","M51360","M47817","M4317","M5116","M4316","R399","I5032","I110","R051","M25562","M542","M5450","Z01810","R0602","H353221","N3943","H53141","H04123","M79674","M79675","M8580","M79651","M25061","Q6100","S161XXA","H353222","H02403","M51370","M47816","M25462","R350","M25461","S32020A","L821","Z01812","N281","D1801","D489"],"date":["2023-11-08","2024-08-22","2025-08-26","2025-05-28","2025-09-10","2023-05-08","2025-12-30","2024-02-26","2025-12-30","2025-12-30","2024-02-07","2026-02-18","2025-11-24","2024-10-24","2023-09-26","2025-11-04","2023-09-26","2026-01-07","2025-08-19","2024-10-21","2024-12-06","2023-10-19","2024-10-21","2024-12-06","2023-11-08","2024-10-21","2023-11-08","2023-11-16","2023-11-16","2023-11-16","2023-11-16","2023-11-22","2023-11-22","2023-11-16","2023-12-03","2023-12-07","2025-10-20","2023-12-07","2024-10-14","2023-12-03","2025-09-08","2026-01-09","2024-12-06","2024-02-02","2025-11-04","2024-02-01","2024-02-22","2024-03-05","2024-03-05","2025-11-24","2024-02-26","2024-02-26","2024-02-26","2024-02-26","2024-03-15","2025-05-05","2024-03-15","2024-03-05","2024-03-05","2024-10-22","2024-03-05","2024-03-05","2024-03-08","2024-10-22","2024-05-14","2024-02-07","2024-06-20","2024-04-30","2024-04-30","2024-06-14","2025-11-01","2025-06-17","2024-06-10","2024-07-10","2026-02-18","2025-11-24","2025-11-24","2025-11-24","2025-11-01","2025-11-01","2025-11-01","2025-11-01","2026-02-18","2026-02-18","2024-08-05","2025-12-05","2026-02-06","2024-08-05","2024-12-06","2025-07-15","2025-11-01","2026-01-02","2024-08-22","2023-03-22","2024-10-21","2025-04-18","2025-04-18","2026-03-02","2026-03-02","2025-12-05","2026-02-18","2026-02-18","2024-08-22","2025-03-21","2024-10-14","2024-10-14","2025-07-30","2025-07-30","2025-01-15","2025-03-06","2026-02-10","2024-10-03","2024-10-24","2025-04-02","2024-08-22","2023-03-16","2023-03-16"],"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":[["","","KETOROLAC","10 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","CLINDAMYCIN","300 MG","","Select","Select",""],["","","LEVOFLOXACIN","250 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","Calcitonin-Salmon 200 Units Nas Spray Par","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Ointment Fougera","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","Calcitonin-Salmon 200 Units Nas Spray Apot","","","Select","Select",""],["","","ANASTROZOLE","1 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AMLODIPINE\/BENAZEPRIL","5\/40 MG","","Select","Select",""],["","","CALCITONIN-SALMON","200 UNITS","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","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":""}]}]}