{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jennifer Jordan Trombley","gend":1,"currentgend":"","add":"106 REGAN LN","city":"PORTLAND","state":"ME","zip":"04103","dob":"1954-09-27","age":"","mstatus":"","insh":"10000093927","cliId":"","pno":"2072324745","cno":"","email":"jkjordan054@gmail.com","ename":"","eno":"","pphy":"MOHAN, ELIZABETH A","ppno":"","pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2078788209","add2":"","add3":"","madd1":"106 REGAN LN","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":"","pcpnpi":"1952622151","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1NR2WX0UP13","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L111","Z85828","L821","L570","L820","R197","R7309","R0609","I10","L659","I480","J302","E785","I77810","L03012","H2513","H3589","H2512","H5203","I4891","I2510","R519","R42","G319","I672","Z8673","M25562","R112","H8110","M1712","M25462","M170","Z7901","I2584","R5383","M79605","M79604","M79601","M6281","R059","M25512","M353","D649","K219","K3189","K449","K760","R1013","B078","M859","R82998","D485","L578","R079","I4710","M1711","I6523","M810","R7303","Z1159","M8580","Z7952","Z79899","R7989","I614","Z0001","A000","E559","R7301","I619","M546","E7800","M8589","C44712","I629","M150","R609","F32A","H00012","S99921A","H532","I69898","H903","S92911A","R001","M180","Z6825","I69198","R2241","S99911A","H524","Z6824","M4726","M5114","H02831","H02834","S8991XA","E119","M47814","Z9109","R220","J029"],"date":["2023-06-20","2025-11-11","2025-09-18","2025-11-11","2023-09-26","2023-07-18","2023-07-18","2024-11-11","2025-10-10","2023-08-08","2026-01-30","2023-08-08","2025-10-10","2024-11-11","2023-05-08","2024-09-16","2025-11-06","2023-08-28","2025-07-24","2024-10-01","2025-08-08","2024-07-03","2023-10-13","2023-10-06","2023-10-06","2025-06-06","2023-10-16","2023-10-07","2023-10-07","2025-08-14","2023-10-16","2023-10-27","2024-04-08","2024-09-27","2026-02-11","2024-04-28","2024-04-28","2024-04-28","2024-04-30","2024-04-30","2024-04-26","2026-02-11","2024-07-03","2024-10-01","2024-05-22","2024-05-22","2024-05-29","2024-05-29","2024-05-30","2024-10-07","2024-07-12","2025-06-20","2025-11-11","2025-08-08","2025-10-15","2025-09-04","2025-10-23","2025-08-15","2025-10-10","2025-10-10","2025-10-10","2026-01-08","2026-02-11","2026-02-11","2025-11-17","2025-10-02","2025-10-29","2026-02-11","2026-02-11","2025-11-17","2025-09-09","2025-06-06","2024-07-30","2025-07-01","2025-10-24","2025-11-03","2024-10-22","2024-10-01","2025-02-21","2025-11-14","2025-12-04","2025-12-04","2025-11-25","2025-11-14","2025-10-23","2025-05-28","2025-05-28","2025-11-28","2026-01-06","2025-11-14","2025-07-24","2025-04-18","2025-10-17","2025-10-17","2024-09-16","2024-09-16","2025-11-20","2024-10-01","2025-09-19","2023-01-20","2023-01-20","2023-01-27"],"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":[["","","KEVZARA","","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","PREDNISONE","1 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","ZOLPIDEM","5 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","MECLIZINE","25 MG","","Select","Select",""],["","","AMLODIPINE","2.5 MG","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","METOPROLOL SUCC","50 MG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","Erythromycin 0.5 % Ophth Oint B&L","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Prasco","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","CELECOXIB","100 MG","","Select","Select",""],["","","PRAVASTATIN","20 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ERYTHROMYCIN","0.005","","Select","Select",""],["","","ESTRADIOL","0.0001","","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":""}]}]}