{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nathan G Trefethen","gend":0,"currentgend":"","add":"45 CAPE JELLISON RD","city":"STOCKTON SPRINGS","state":"ME","zip":"04981","dob":"1957-04-27","age":"","mstatus":"","insh":"10000095213","cliId":"","pno":"2077023385","cno":"","email":"","ename":"","eno":"","pphy":"CHEFF, SUSAN E","ppno":"","pcpadd":"Helen Hunt Health Center,242 Brunswick St","pcpcity":"Old Town","pcpstate":"ME","pcpzip":"04468","pcpcounty":"","pcpid":"","pcpname":"ADULT WELLNESS CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 242","madd2":"","madd3":"","mcity":"STOCKTON SPRINGS","mstate":"ME","mzip":"04981","pcpfaxno":"2079470435","pcpnpi":"1548365810","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9KR8W37CH47","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","Z0000","Z136","Z87891","R6889","S39012A","M549","K5900","S39012S","J90","J9811","R188","R932","K5730","N2889","E871","R931","I745","Z452","J984","D72810","R1909","C8513","R579","I2510","I5189","I253","C8512","K689","R590","R7402","E8720","C8510","E790","K668","R0902","R7881","C8333","Z4682","R918","J811","I510","M9903","M5450","M9905","M4607","R2232","R1310","T17300A","I4891","R578","J9601","C8330","G9349","J948","K921","E870","J910","E440","K2210","J449","K2211","B3781","G7281","I5022","E46","I110","I429","Z8572","Z23","Z5111","Z711","C8338","R222","R0789","N644","K429","N3289","C833A","R229","R739","R339","N62","E039","B351"],"date":["2025-07-16","2026-01-14","2024-01-22","2024-01-22","2023-12-23","2024-04-11","2024-04-26","2024-04-29","2024-05-03","2024-07-29","2024-05-21","2024-05-13","2024-05-13","2026-01-15","2024-05-13","2024-05-15","2024-05-20","2024-05-15","2024-05-14","2024-05-27","2024-05-14","2024-05-24","2024-05-19","2024-05-23","2026-01-15","2024-05-22","2024-05-14","2024-05-14","2024-05-17","2024-07-29","2024-05-15","2024-05-22","2024-05-26","2024-05-22","2024-05-18","2024-05-26","2024-05-26","2024-07-28","2024-05-31","2024-10-15","2024-05-24","2024-05-22","2024-05-07","2024-05-07","2024-05-07","2024-05-07","2024-05-27","2024-06-27","2024-06-12","2024-06-27","2024-05-22","2024-05-25","2025-01-31","2024-05-25","2024-05-14","2024-05-31","2024-05-31","2024-05-31","2024-06-20","2024-05-31","2024-06-12","2024-05-31","2024-05-31","2024-06-27","2024-06-27","2024-06-27","2024-06-28","2024-06-20","2026-01-15","2026-01-23","2024-09-18","2025-11-17","2025-01-29","2024-11-21","2025-01-09","2025-01-09","2025-07-15","2026-01-15","2025-04-29","2025-01-09","2025-03-14","2025-07-16","2025-01-24","2025-12-12","2023-02-09"],"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":[["","","Triamcinolone Acet 0.025 % Cream Fougera","","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","LEVOTHYROXINE","75 MCG","","Select","Select",""],["","","PROCHLORPERAZINE","10 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","DIGOXIN","0.125 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","CYCLOBENZAPRINE","5 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","METOPROLOL SUCC","50 MG","","Select","Select",""],["","","QUETIAPINE","25 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","AMLODIPINE","10 MG","","Select","Select",""],["","","ACYCLOVIR","400 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","LISINOPRIL\/HYDROCHLOROTHIAZIDE","10\/12.5 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","Ketoconazole 2 % Shampoo Padagis","","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.00025","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","PREVNAR","","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","KETOCONAZOLE","0.02","","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":""}]}]}