{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sherry Y Tremblay","gend":1,"currentgend":"","add":"23 ISLAND VIEW LN","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1957-05-15","age":"","mstatus":"","insh":"10000097111","cliId":"","pno":"2076070835","cno":"","email":"sytremblay@gmail.com","ename":"","eno":"","pphy":"CARR, SUZANNE","ppno":"2073734700","pcpadd":"Parkview Family Health,329 Maine St","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"23 ISLAND VIEW LN","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":"2078287850","pcpnpi":"1679513402","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6EY3DJ5NN08","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","L299","L814","L578","Z85828","E559","M8589","Z13820","H26493","H35371","J029","Z1231","Z1211","K5730","M79662","R051","M67879","D71","R918","J929","R059","N952","L900","L304","R6889","H6123","R509","R052","D869","R0789","D860","R42","R7301","Z01419","Z9189","L439","L249"],"date":["2023-06-06","2023-05-26","2024-05-23","2024-05-23","2024-05-23","2023-12-15","2023-06-21","2023-06-21","2023-08-07","2024-07-01","2023-08-10","2023-08-18","2023-08-24","2023-08-24","2023-10-30","2023-11-16","2023-10-30","2023-11-16","2023-12-15","2023-11-16","2024-01-15","2023-12-20","2024-05-31","2023-12-20","2023-04-25","2024-01-16","2024-01-15","2024-01-15","2024-04-23","2024-04-23","2024-04-23","2024-04-23","2024-05-24","2024-05-31","2024-05-31","2024-05-31","2024-05-23"],"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 0.1 % Ointment Taro","","","Select","Select",""],["","","Mometasone 0.1 % Ointment Padagis","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Miebo","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Amlodipine","2.5 MG","","Select","Select",""],["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Paxlovid","300\/100 MG","","Select","Select",""],["","","Shingrix","","","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":""}]}]}