{"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":["H6992","Z471","M8580","Z96612","E782","H9122","Z87891","Z96611","Z08","M25512","M19012","Z86000","G8918","I2510","R931","R9439","I10","H9042","M12811","M25511","I5189","I493","I209","L989","N9489","K219","L308","D0512","Z01818","R051","Z98890","H903","Z0000","E6601","J189","R062","R059","R0989","M75122","M19212","F429","R6884","H9312","Z8619","H938X2","Z713","L089","H918X3","L309","I444","I5032","R0982","F419","F4323","Z1211","I25118","G4730","G2581","R079","K621","K5730","M75101","M67813","M94211","Z13820","M67921","Z0100","Z0389","Z8701","R634","Z6837","I5030","I517","I3489","I358"],"date":["2024-09-23","2026-03-17","2023-11-14","2025-05-06","2025-07-21","2024-11-27","2024-11-21","2026-03-19","2026-04-10","2024-02-09","2024-08-02","2026-04-10","2025-07-11","2024-01-19","2024-01-19","2024-01-19","2024-01-19","2025-10-21","2025-07-11","2025-05-06","2023-11-28","2023-11-28","2024-01-08","2026-03-12","2025-12-11","2025-07-11","2026-04-07","2024-04-11","2024-04-23","2024-09-12","2024-05-14","2025-10-21","2026-02-02","2025-11-18","2024-09-12","2024-09-12","2024-09-12","2024-09-12","2024-05-02","2024-05-02","2023-06-14","2026-01-23","2024-11-01","2024-11-01","2024-11-01","2024-06-12","2026-04-07","2024-10-08","2026-04-07","2023-09-21","2025-05-28","2023-09-21","2023-05-16","2026-03-19","2023-07-31","2025-03-17","2025-07-11","2025-11-18","2023-09-21","2023-07-31","2023-07-31","2025-07-11","2025-07-11","2025-07-11","2024-02-27","2025-07-11","2026-01-15","2024-02-27","2024-10-24","2023-06-14","2023-06-14","2025-03-17","2025-03-17","2025-03-17","2025-03-17"],"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":[["","","Rosuvastatin","20 MG","","Select","Select",""],["","","Clindamycin 2 % Vag Cream Fougera","","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Lovastatin","10 MG","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","Valacyclovir","500 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Clobetasol 0.05 % Cream Taro","","","Select","Select",""],["","","Escitalopram","20 MG","","Select","Select",""],["","","Gabapentin","100 MG","","Select","Select",""],["","","Losartan\/Hydrochlorothiazide","50\/12.5 MG","","Select","Select",""],["","","Clobetasol 0.05 % Cream Encube","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","Zepbound","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Losartan-Hydrochlorothiazide","","","Select","Select",""],["","","Cefuroxime","500 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Acetaminophen\/Codeine Phos","300\/30 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":""}]}]}