{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pearl A Beaulieu","gend":1,"currentgend":"","add":"8 BEAU LN","city":"BIDDEFORD","state":"ME","zip":"04005","dob":"1957-09-15","age":"","mstatus":"","insh":"10000099300","cliId":"","pno":"2072844274","cno":"2078490476","email":"p.beaulieu@live.com","ename":"","eno":"","pphy":"BLACK, MEGAN L","ppno":"2077711717","pcpadd":"Portland Internal Medicine,43 Baxter Blvd","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 BEAU LN","madd2":"","madd3":"","mcity":"BIDDEFORD","mstate":"ME","mzip":"04005","pcpfaxno":"2077711729","pcpnpi":"1982056347","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1H32FJ1GV08","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0600","J45901","Z136","R059","R600","E876","E042","E041","J4540","J4520","R490","E785","E119","I509","I10","L900","L439","L308","L438","L578","K219","R498","H9190","H43813","Z5111","C3412","J45909","R4182","C3490","R911","R197","C3492","I2699","J3800","J3801","Z5112","L089","Z483","R2241","I82411","L820","Z86711","M79671","C771","D125","K625","K5730","K921","Z48813","J90","Z4682","Z01818","I82431","I82401","N83292","Z98890","J811","N949","J939","M7661","Z87891","J439","R918","R300","L0390","N289"],"date":["2023-04-16","2025-06-25","2025-09-29","2023-04-16","2023-04-16","2023-08-31","2025-06-25","2023-10-02","2025-08-04","2023-06-05","2025-11-10","2025-04-10","2025-12-15","2024-04-29","2025-09-15","2025-11-04","2023-11-06","2023-11-07","2025-11-04","2025-11-04","2024-05-01","2023-12-06","2023-12-06","2024-02-08","2025-10-14","2026-02-26","2025-04-10","2025-04-10","2026-02-27","2026-02-27","2023-03-20","2025-06-30","2025-10-01","2025-11-10","2025-11-10","2026-02-19","2024-11-05","2025-07-30","2025-11-07","2025-12-09","2025-11-04","2026-01-08","2025-09-29","2025-06-25","2026-02-27","2026-02-27","2026-02-27","2026-02-27","2025-07-07","2026-01-09","2025-06-26","2026-02-27","2025-09-27","2025-12-09","2025-02-28","2025-06-25","2025-06-26","2025-02-28","2025-06-27","2025-09-27","2025-09-27","2025-06-12","2025-06-12","2025-11-26","2025-11-26","2023-02-06"],"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":[["","","Clobetasol 0.05 % Ointment Taro","","","Select","Select",""],["","","FREESTYLE LITE","","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Northstar","","","Select","Select",""],["","","Onetouch Ultra 2","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","Cortifoam","","","Select","Select",""],["","","DEXAMETHASONE","4 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","LOSARTAN","100 MG","","Select","Select",""],["","","FREESTYLE","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","IBUPROFEN","800 MG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","Clobetasol 0.05 % Cream Encube","","","Select","Select",""],["","","CYCLOBENZAPRINE","10 MG","","Select","Select",""],["","","GLIPIZIDE","5 MG","","Select","Select",""],["","","DOXAZOSIN","1 MG","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","PROCHLORPERAZINE","10 MG","","Select","Select",""],["","","Clobetasol 0.05 % Top Sol Macleods","","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","MONTELUKAST","10 MG","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","Clobetasol 0.05 % Cream Taro","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","FREESTYLE FREEDOM LITE","","","Select","Select",""],["","","MORPHINE","15 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LORAZEPAM","0.5 MG","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","ALBUTEROL (","0.083%) 2.5","","Select","Select",""],["","","CLOBETASOL","0.0005","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","Select","Select",""],["","","ONETOUCH ULTRA","","","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":""}]}]}