{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kimberly J Austin","gend":1,"currentgend":"","add":"514 BRIGHTON RD","city":"SOLON","state":"ME","zip":"04979","dob":"1957-08-14","age":"","mstatus":"","insh":"10000104676","cliId":"","pno":"2076129856","cno":"","email":"kim.austin35@gmail.com","ename":"","eno":"","pphy":"CLARCQ, LISA A","ppno":"2078731098","pcpadd":"149 North St,","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"514 BRIGHTON RD","madd2":"","madd3":"","mcity":"SOLON","mstate":"ME","mzip":"04979","pcpfaxno":"2078731624","pcpnpi":"1346368925","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1Q03E05ND91","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D0512","F429","F419","I10","R634","Z6837","Z1211","K621","K5730","R079","R0982","I444","K219","M8580","I209","R9439","E782","Z0000","I2510","R931","M19012","M25512","I5189","I493","Z0389","Z13820","Z01818","Z713","G8918","M75122","M19212","Z96612","Z98890","Z471","I5032"],"date":["2024-04-11","2023-06-14","2023-05-16","2024-01-19","2023-06-14","2023-06-14","2023-07-31","2023-07-31","2023-07-31","2023-09-21","2023-09-21","2023-09-21","2024-05-02","2023-11-14","2024-01-08","2024-01-19","2024-05-02","2023-12-14","2024-01-19","2024-01-19","2024-06-04","2024-02-09","2023-11-28","2023-11-28","2024-02-27","2024-02-27","2024-04-23","2024-06-12","2024-05-02","2024-05-02","2024-05-02","2024-06-13","2024-05-14","2024-05-14","2024-06-18"],"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":[["","","Valacyclovir","500 MG","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Cefuroxime","500 MG","","Select","Select",""],["","","Clindamycin 2 % Vag Cream Fougera","","","Select","Select",""],["","","Escitalopram","20 MG","","Select","Select",""],["","","Rosuvastatin","20 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Acetaminophen\/Codeine Phos","300\/30 MG","","Select","Select",""],["","","Zepbound","","","Select","Select",""],["","","Clobetasol 0.05 % Cream Encube","","","Select","Select",""],["","","Metronidazole","500 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":""}]}]}