{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia A Graffam","gend":1,"currentgend":"","add":"9 MCKINLEY ST","city":"EASTPORT","state":"ME","zip":"04631","dob":"1945-11-24","age":"","mstatus":"","insh":"10000095876","cliId":"","pno":"2078534781","cno":"","email":"dpgraffam@myfairpoint.net","ename":"","eno":"","pphy":"RICHARDSON, WILLIAM B","ppno":"2078536001","pcpadd":"Eastport Health Care Inc,30 Boynton St","pcpcity":"Eastport","pcpstate":"ME","pcpzip":"04631","pcpcounty":"","pcpid":"","pcpname":"EASTPORT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9 MCKINLEY ST","madd2":"","madd3":"","mcity":"EASTPORT","mstate":"ME","mzip":"04631","pcpfaxno":"3158292014","pcpnpi":"1457409617","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1M74YP9TG61","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","F419","M1611","Z0001","H40023","H43393","H2513","F410","Z01810","M169","I252","I083","M25851","M25751","I70201","Z01812","I10","Z471","Z01818","Z96641","Z96643","M62830","S3210XD","S3219XA","R300","S3210XA","M549","Z8781","J449","S3282XA","N390","R5381","I5031","I081","I700","I5032","Z23","R9389","J439","Z0000","Z09","E876","F325","M150"],"date":["2025-03-12","2026-02-26","2024-01-10","2023-06-09","2024-12-17","2024-12-17","2024-12-17","2024-12-18","2023-09-25","2023-09-25","2023-09-25","2023-11-30","2023-12-28","2023-12-28","2023-12-28","2023-11-08","2024-09-27","2024-05-30","2024-01-10","2026-01-12","2024-02-22","2024-03-26","2024-04-29","2024-04-01","2024-04-08","2024-03-28","2024-04-03","2024-05-08","2025-09-04","2024-05-30","2024-05-13","2025-01-06","2025-09-06","2025-09-08","2025-09-08","2025-11-13","2025-10-28","2024-07-11","2025-09-06","2024-09-06","2026-01-12","2025-09-22","2024-09-27","2024-09-27"],"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":[["","","NAPROXEN","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","ENALAPRIL","5 MG","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","CEFUROXIME","500 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","ALPRAZOLAM","0.25 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","ALBUTEROL\/IPRATROPIUM","3\/0.5 MG\/3","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","Ipratropium 0.06 % Nas Spray Advagen","","","Select","Select",""],["","","Ipratropium 0.06 % Nas Spray Amneal","","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","METHOCARBAMOL","500 MG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","Calcitonin-Salmon 200 Units Nas Spray Apot","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","DULOXETINE","30 MG","","Select","Select",""],["","","IPRATROPIUM","0.0006","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","CHLORHEXIDINE","0.0012","","Select","Select",""],["","","CALCITONIN-SALMON","200 UNITS","","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":""}]}]}