{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dolores A Lones","gend":1,"currentgend":"","add":"1 WILD DUNES WAY APT 21","city":"OLD ORCHARD BEACH","state":"ME","zip":"04064","dob":"1947-10-15","age":"","mstatus":"","insh":"10000103223","cliId":"","pno":"2077101964","cno":"","email":"doloreslones25@gmail.com","ename":"","eno":"","pphy":"CARPENTER, LISA H","ppno":"2072823349","pcpadd":"SMHC Internal Medicine, 46 Barra Rd Ste 201","pcpcity":"Biddeford","pcpstate":"ME","pcpzip":"04005","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1 WILD DUNES WAY APT 21","madd2":"","madd3":"","mcity":"OLD ORCHARD BEACH","mstate":"ME","mzip":"04064","pcpfaxno":"2072826099","pcpnpi":"1821418716","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6PC0TA4UG05","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z471","M25551","Z96641","G4733","R7303","Z0100","E119","R29898","I5032","E782","M160","R748","I110","I5030","E785","K589","M1611","M67853","G4739","M79604","R94131","M5416","E7849","M810","Z780","M25461","M25561","K580","M79651","Z0000","N1831","E6601","Z6841","E559","R1031","Z1231","M109","Z79899","M7061","E66812","Z6836","G8929","R059","Z01818","R4182","Z6839","Z853","R922"],"date":["2024-10-04","2025-07-02","2025-04-04","2026-02-02","2025-09-05","2025-03-31","2025-03-31","2025-03-17","2025-09-30","2024-12-06","2024-05-03","2025-01-14","2024-07-22","2024-07-29","2024-07-22","2025-03-05","2025-03-17","2025-03-17","2026-02-12","2025-01-31","2025-01-31","2025-01-31","2024-07-31","2026-01-07","2025-02-18","2025-08-08","2025-08-08","2024-12-30","2024-07-24","2025-06-04","2025-12-04","2024-07-08","2023-11-28","2024-05-22","2024-04-27","2026-02-19","2024-07-29","2024-07-29","2025-05-23","2025-12-30","2025-12-30","2025-08-08","2024-01-05","2024-06-18","2024-07-08","2025-10-28","2023-07-20","2023-07-20"],"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":[["","","Tramadol","50 MG","","Select","Select",""],["","","Hydromorphone","2 MG","","Select","Select",""],["","","Ropinirole","1 MG","","Select","Select",""],["","","Atenolol","25 MG","","Select","Select",""],["","","Oseltamivir","30 MG","","Select","Select",""],["","","Simvastatin","40 MG","","Select","Select",""],["","","Amitriptyline","10 MG","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Amitriptyline Hcl","","","Select","Select",""],["","","Bumetanide","2 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Pregabalin","50 MG","","Select","Select",""],["","","Zepbound","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Allopurinol","300 MG","","Select","Select",""],["","","Potassium Cl","20 MEQ","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Alendronate","70 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":""}]}]}