{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia A Kurtz","gend":1,"currentgend":"","add":"8 COBB RD","city":"LEE","state":"ME","zip":"04455","dob":"1943-12-02","age":"","mstatus":"","insh":"10000113153","cliId":"","pno":"2077385025","cno":"","email":"maineleeceramics@yahoo.com","ename":"","eno":"","pphy":"KLOSOWSKI, KYLE","ppno":"2079746700","pcpadd":"Health Access Network,175 W Broadway","pcpcity":"Lincoln","pcpstate":"ME","pcpzip":"04457","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 COBB RD","madd2":"","madd3":"","mcity":"LEE","mstate":"ME","mzip":"04455","pcpfaxno":"","pcpnpi":"1477231017","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9Q72QT9WD28","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F419","E1151","E1165","E119","H25813","H40033","I10","E782","E039","M316","M546","R0781","W19XXXA","L570","L97911","K5730","H2512","H40219","H2511","K429","H4020X1","H6692","L03115","I2510","Z45018","L309","Z7189","K5792","E1141","R197","R1084","R509","E860","K5732","K5900","I495","Z950","R1030","K7689","R109","I4589","N289","L400","T1490XD","I455","M5450","I5030","I480","I3139","I517","R0602","R001","I214","Z743","E1140","M5451","R0683","I4891","D649","I700","I3481","Z98890","M26609","I110","I252","I119","R519"],"date":["2024-01-04","2025-03-05","2025-12-09","2025-02-25","2025-08-28","2025-02-25","2024-12-05","2024-04-24","2024-04-24","2024-04-24","2026-02-26","2026-02-26","2026-02-26","2025-12-15","2025-11-03","2024-10-11","2026-02-05","2025-10-28","2025-12-11","2024-07-29","2025-08-28","2024-07-16","2025-11-10","2025-01-07","2025-11-12","2025-12-15","2025-12-15","2024-08-06","2025-11-19","2025-02-12","2024-08-07","2024-08-06","2025-08-05","2024-08-07","2024-08-06","2025-07-29","2025-07-30","2024-09-17","2024-12-13","2024-10-11","2025-07-16","2024-08-12","2025-10-18","2025-11-18","2025-05-06","2025-03-11","2024-12-13","2025-05-12","2025-02-11","2024-12-13","2025-06-16","2025-06-16","2024-12-06","2024-12-06","2025-04-15","2025-06-12","2025-05-19","2024-12-27","2025-02-10","2025-02-11","2025-02-11","2024-11-20","2024-11-08","2024-12-06","2025-01-07","2025-01-07","2024-12-05"],"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",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","CYCLOBENZAPRINE","10 MG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","Onetouch Ultra 2","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Lupin","","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","CARVEDILOL","12.5 MG","","Select","Select",""],["","","Baclofen","10 MG","","Select","Select",""],["","","ONETOUCH ULTRA","","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","MECLIZINE","25 MG","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","LOSARTAN","100 MG","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","LINZESS","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PRIMIDONE","125 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","Hydrocortisone 2.5 % Ointment Perrigo","","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","ONETOUCH DELICA PLUS","","","Select","Select",""],["","","LOPERAMIDE","2 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","Naproxen","500 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","Fluorouracil 5 % Cream Taro","","","Select","Select",""],["","","CHLORTHALIDONE","50 MG","","Select","Select",""],["","","HYDROCORTISONE","0.025","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","CLOBETASOL","0.0005","","Select","Select",""],["","","MUPIROCIN","0.02","","Select","Select",""],["","","FLUOROURACIL","0.05","","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":""}]}]}