{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dorothy E Hartman","gend":1,"currentgend":"","add":"15 NAUTICAL DR","city":"CUMBERLAND FORESIDE","state":"ME","zip":"04110","dob":"1933-07-27","age":"","mstatus":"","insh":"10000090494","cliId":"","pno":"2076506887","cno":"","email":"dhart703@hotmail.com","ename":"","eno":"","pphy":"PIERCE, DANIEL C","ppno":"2078469013","pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 NAUTICAL DR","madd2":"","madd3":"","mcity":"CUMBERLAND FORESIDE","mstate":"ME","mzip":"04110","pcpfaxno":"2078741483","pcpnpi":"1861451080","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8WM8V44EE61","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M8580","E785","L84","Z0001","J984","R079","R002","R051","R110","I4891","J189","R9389","H04123","Z4689","N812","N952","N3946","I2510","I700","I3481","I480","I25111","I350","R918","I083","I428","I200","I10","R911","I25110","I2584","R931","Z23","Z7901","S0990XA","J8410","J181","H35372","N813","N390","R350","Z129","Z1231","M810","R5382","N1831","D631","H16143","D508","R5383","I080","R3915","M25561","Z0000","M1711","M25461","M25761","R0609","H16223","Z952","Z01818","J811","R4182","Z006","F439","R627","Z954","R0602","R059","R519","H538","I6523","I081","R410","R4781","I69318","R262","Z736","I509","S300XXA","W19XXXA","G3184","R296","I674","Z136","T148XXA","A000","R6889","S299XXA","R531","S52572D","S3993XA","S3991XA","S199XXA","W1849XA","J90","Z9189","I491","I4710","R413","R2689","I708","J9601","M1712","I5033","S52592D","S52612D","R0902","M25532","M25552","G9340","N179","R053","H539","Z8673","S52572A","Z0101","S52612A","G43009","R9431","L309","J00","G939","H547","I499","R109","S300XXD","A419","H5319","S62102A","D649","Z8679","Z953","G9341","Z66","Z743"],"date":["2024-04-09","2025-04-15","2024-04-16","2025-04-28","2023-04-22","2025-12-07","2023-04-23","2023-04-22","2023-04-22","2025-12-18","2025-12-03","2023-06-21","2025-10-15","2025-11-17","2025-11-17","2025-11-17","2025-11-17","2026-01-06","2023-05-26","2023-05-26","2026-01-12","2023-06-04","2025-10-31","2023-06-02","2024-06-27","2023-06-02","2023-06-09","2025-12-18","2023-10-19","2023-06-06","2023-06-06","2025-10-11","2025-10-03","2025-10-11","2025-10-30","2023-06-21","2023-10-19","2023-07-10","2023-09-18","2023-09-18","2023-09-14","2023-09-21","2023-09-21","2023-09-21","2023-10-09","2024-12-27","2025-04-15","2023-11-28","2023-12-11","2026-01-13","2024-05-30","2024-01-05","2024-04-23","2025-03-29","2025-08-06","2025-08-06","2024-04-23","2024-04-30","2024-12-02","2025-10-11","2024-06-21","2025-12-02","2025-12-10","2024-07-08","2024-06-19","2024-07-06","2024-10-01","2025-12-03","2024-07-06","2024-07-06","2024-07-05","2025-10-10","2025-10-11","2024-07-09","2024-07-09","2025-03-30","2025-12-18","2025-12-18","2026-01-27","2025-11-02","2025-11-02","2026-01-02","2025-11-21","2024-07-08","2025-12-04","2025-11-10","2025-11-03","2025-05-01","2025-10-31","2025-12-01","2025-05-29","2025-10-31","2025-10-31","2025-10-31","2025-10-30","2026-01-20","2025-10-31","2024-10-01","2024-10-01","2024-12-01","2025-11-02","2025-10-31","2026-01-21","2025-12-03","2026-01-13","2025-04-17","2025-04-17","2025-12-02","2025-05-05","2025-12-03","2025-12-10","2025-12-18","2026-01-20","2025-10-11","2025-10-11","2025-03-20","2024-08-23","2025-03-20","2025-10-11","2024-09-17","2025-09-24","2025-12-03","2025-12-03","2025-10-11","2025-10-11","2025-12-08","2025-11-03","2025-12-01","2025-10-15","2025-03-11","2025-10-11","2025-10-11","2025-07-28","2025-12-01","2025-12-01","2025-12-10"],"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":[["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Taro","","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Perrigo","","","Select","Select",""],["","","DABIGATRAN ETEXILATE","150 MG","","Select","Select",""],["","","Morphine Conc","100 MG","","Select","Select",""],["","","MIRTAZAPINE","7.5 MG","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","AMLODIPINE","10 MG","","Select","Select",""],["","","ALENDRONATE","70 MG","","Select","Select",""],["","","LOSARTAN","100 MG","","Select","Select",""],["","","Erythromycin 0.5 % Ophth Oint Perrigo","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Tobramycin\/Dex 0.3\/0.1 % Ophth Susp Padagi","","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","Erythromycin 0.5 % Ophth Oint B&L","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","Select","Select",""],["","","TOBRAMYCIN\/DEX","0.3\/0.1 %","","Select","Select",""],["","","ERYTHROMYCIN","0.005","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","MORPHINE CONC (","100 MG\/5","","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":""}]}]}