{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Debra L Hyde","gend":1,"currentgend":"","add":"138 MT AUBURN AVE UNIT 313","city":"Auburn","state":"ME","zip":"04210","dob":"1958-01-02","age":"","mstatus":"","insh":"10000104869","cliId":"","pno":"2073767724","cno":"2073767724","email":"Hydedebra2007@gmail.com","ename":"","eno":"","pphy":"SIRKA, REBECCA","ppno":"2077847388","pcpadd":"Family Health Care Associates,190 Stetson Rd","pcpcity":"Auburn","pcpstate":"ME","pcpzip":"04210","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"138 MT AUBURN AVE UNIT 313","madd2":"","madd3":"","mcity":"Auburn","mstate":"ME","mzip":"04210","pcpfaxno":"2077952043","pcpnpi":"1477107647","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7XY0AQ3WC48","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I480","I493","I471","R008","K5900","K5790","K219","R002","I10","Z0000","F419","E0590","E7800","H16223","H0288A","H0288B","L719","K5792","M62830","M5450","I341","R29898","N949","N8110","Z1231","R399","K640","E782","R300","N390","E785","N952","R1011","N1330","N83201","N2882","R109","K5909","R3129","H538","R5383","R001","I4710","R42","E039","R040","M8580","R609","I499","R9431","I517","I361","R252","R6889","R102","Z09","G2581","F411","G479","Q638","L578","L814","L821","L570","K5732","R1032","R110","R790","G43909"],"date":["2024-06-04","2024-06-04","2023-04-06","2023-04-06","2023-08-25","2024-05-29","2024-05-29","2023-12-19","2024-05-29","2024-04-12","2024-06-13","2024-06-19","2023-04-20","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2024-05-11","2023-05-15","2023-05-19","2024-05-29","2023-05-09","2023-06-19","2023-07-29","2024-07-05","2023-06-27","2023-07-06","2023-09-06","2023-07-29","2023-07-29","2024-04-12","2023-08-03","2023-08-25","2024-03-26","2023-08-25","2023-08-25","2024-03-19","2024-05-29","2023-09-06","2023-09-29","2023-09-29","2023-11-01","2023-11-17","2023-10-31","2023-10-31","2023-11-20","2023-11-20","2023-11-27","2023-11-01","2023-11-01","2023-11-01","2023-11-01","2024-04-05","2023-12-17","2024-02-07","2024-02-06","2024-02-19","2024-02-26","2024-06-13","2024-03-19","2024-03-07","2024-03-07","2024-03-07","2024-03-07","2024-05-08","2024-05-08","2024-05-08","2024-06-13","2024-06-13"],"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":[["","","Restasis","","","Select","Select",""],["","","Sucralfate","1 GM","","Select","Select",""],["","","Methimazole","5 MG","","Select","Select",""],["","","Sumatriptan","100 MG","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Fluoxetine","10 MG","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Escitalopram","5 MG","","Select","Select",""],["","","Estradiol 0.1%","1 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Losartan","25 MG","","Select","Select",""],["","","Carvedilol","6.25 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Metronidazole 0.75 % Cream Fougera","","","Select","Select",""],["","","Amitriptyline","10 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Azithromycin","500 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Loteprednol 0.5 % Ophth Gel Armas","","","Select","Select",""],["","","Hydralazine","10 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","Atenolol","25 MG","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Chlorthalidone","25 MG","","Select","Select",""],["","","Metoprolol Succ","25 MG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","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":""}]}]}