{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathy J Lever","gend":1,"currentgend":"","add":"176 CAMPBELL POND RD","city":"West Bath","state":"ME","zip":"04530","dob":"1952-07-04","age":"","mstatus":"","insh":"10000095702","cliId":"","pno":"2075227877","cno":"","email":"kjlever@gmail.com","ename":"","eno":"","pphy":"KAPALA, CHRISTINA ANNE","ppno":"2076620111","pcpadd":"108 CENTRE ST,","pcpcity":"BATH","pcpstate":"ME","pcpzip":"45302550","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"176 CAMPBELL POND RD","madd2":"","madd3":"","mcity":"West Bath","mstate":"ME","mzip":"04530","pcpfaxno":"2073861801","pcpnpi":"1386080182","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7JH8HH4DC46","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F4323","L602","M2040","F3341","Z0000","C439","E782","J4530","K130","H01134","M25579","S93409A","M25572","M25472","S93412A","H00012","Z23","U071","J029","R0981","M7918","M79672","G8929","M25372","H524","Z0101","D225","L578","L814","L821","M25512","M19012","E785","Z1231","H25013","Z13820","M8589"],"date":["2024-01-17","2023-04-19","2023-04-19","2023-05-23","2024-06-04","2023-05-23","2023-05-23","2024-07-12","2023-05-25","2023-05-25","2023-07-16","2023-07-16","2023-11-21","2023-07-16","2023-07-16","2023-09-29","2023-09-29","2023-10-08","2023-10-08","2023-10-08","2023-10-08","2023-11-21","2023-11-21","2024-01-24","2023-12-19","2023-12-19","2024-02-09","2024-02-09","2024-02-09","2024-02-09","2024-06-05","2024-04-08","2024-06-04","2024-06-07","2024-06-11","2024-07-02","2024-07-02"],"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":[["","","Ketoconazole 2 % Cream Teva","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Valacyclovir","1 GM","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Advair Hfa","","","Select","Select",""],["","","Breo Ellipta","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Ointment Fougera","","","Select","Select",""],["","","Epinephrine","0.3 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Glenmark","","","Select","Select",""],["","","Trazodone","50 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":""}]}]}