{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Monique D Hamilton","gend":1,"currentgend":"","add":"11 RIDGEFIELD DR","city":"GORHAM","state":"ME","zip":"04038","dob":"1950-08-07","age":"","mstatus":"","insh":"10000092697","cliId":"","pno":"2074500737","cno":"","email":"mhamilto@maine.rr.com","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":"2077745816","pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 RIDGEFIELD DR","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":"2078741483","pcpnpi":"1134206352","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9NP2R50TR92","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H903","D122","Z1211","K219","E669","K589","Z0101","H35371","M810","M5450","E785","I10","K760","Z1231","M4807","R059","R051","R918","M79644","M19041","R0602","K8020","R109","R509","U071","H66002","E278","H6592","R519","N179","D649","H7092","H748X2","H902","R700","R7989","R6889","L729","G9389","I6782","J0100","Z0001","H7292","R7982","K769","A000","D3501","E248"],"date":["2024-06-18","2023-05-02","2023-05-02","2023-05-02","2023-05-02","2023-05-02","2023-05-19","2023-05-19","2023-06-21","2024-05-18","2023-07-31","2023-07-31","2023-07-31","2023-08-15","2024-02-02","2023-09-23","2024-02-22","2023-09-23","2024-01-30","2024-01-30","2024-02-25","2024-03-26","2024-02-25","2024-02-22","2024-02-26","2024-02-22","2024-07-03","2024-03-13","2024-04-25","2024-03-04","2024-06-26","2024-03-16","2024-03-16","2024-03-13","2024-03-15","2024-03-19","2023-12-31","2024-03-20","2024-03-09","2024-03-09","2024-04-09","2024-03-19","2024-04-18","2024-06-26","2024-03-12","2024-06-27","2024-06-14","2024-06-14"],"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",""],["","","Hydrocortisone","5 MG","","Select","Select",""],["","","Cefpodoxime","200 MG","","Select","Select",""],["","","Ofloxacin 0.3 % Otic Sol Lifestar","","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Imipramine Hcl","50 MG","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Paxlovid","300\/100 MG","","Select","Select",""],["","","Dexamethasone","1 MG","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Prednisone","50 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Methocarbamol","500 MG","","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":""}]}]}