{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nicole J Burnett","gend":1,"currentgend":"","add":"43 SEAPOINT RD","city":"Kittery Point","state":"ME","zip":"03905","dob":"1959-05-31","age":"","mstatus":"","insh":"10000115222","cliId":"","pno":"6035822387","cno":"","email":"Nicolejoyburnett5@gmail.com","ename":"","eno":"","pphy":"STEVENS, MICHAEL J","ppno":"6037750000","pcpadd":"4 ALUMNI DR,","pcpcity":"EXETER","pcpstate":"NH","pcpzip":"38332118","pcpcounty":"","pcpid":"","pcpname":"CORE FAMILY AND INTERNAL MEDICINE OF EXETER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"43 SEAPOINT RD","madd2":"","madd3":"","mcity":"KITTERY POINT","mstate":"ME","mzip":"03905","pcpfaxno":"6037750247","pcpnpi":"1659415859","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6D67Y50DE78","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H04123","H25813","T8131XA","N62","L905","L603","F332","F4381","F418","S52572A","G8918","S52572D","S52571A","S52602A","F32A","Z23","F4310","T8484XA","Z1339","S73192A","M25552","Z4789","S76012D","H25812","M65331","Z0000","N390","H25811","F329","H2511","M71572","H10023","M7062","S76012A","H02881","H02884","R2242","S52532D","S52612A","S52531A","R300","H2512","S76312A","S73192D","Z5321","M79662","M79605","R82998","B351"],"date":["2024-05-06","2024-07-24","2024-10-29","2024-10-29","2024-10-29","2025-05-21","2026-01-22","2026-01-22","2024-12-13","2026-01-15","2026-01-15","2026-02-26","2026-01-14","2026-01-11","2024-09-16","2024-09-16","2026-01-22","2025-11-26","2026-02-12","2025-02-18","2025-03-24","2026-02-26","2025-03-24","2024-10-08","2025-04-25","2025-04-03","2026-01-28","2024-09-12","2024-11-14","2024-09-12","2026-01-29","2024-07-16","2025-07-30","2025-02-18","2024-12-23","2024-12-23","2025-03-03","2026-01-11","2026-01-11","2026-01-11","2026-02-12","2024-10-08","2025-01-20","2025-01-20","2025-02-23","2025-03-03","2025-02-23","2026-02-12","2025-05-21"],"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":[["","","HYDROXYZINE HCL","25 MG","","Select","Select",""],["","","LORAZEPAM","0.5 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","BUPROPION HCL","75 MG","","Select","Select",""],["","","VILAZODONE","10 MG","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","MNEXSPIKE","","","Select","Select",""],["","","CLONAZEPAM","0.5 MG","","Select","Select",""],["","","Fosfomycin","3 GM","","Select","Select",""],["","","PROPRANOLOL","10 MG","","Select","Select",""],["","","LAMOTRIGINE","25 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","Econazole 1 % Cream Taro","","","Select","Select",""],["","","SUMATRIPTAN","100 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","SPRAVATO","","","Select","Select",""],["","","DOXAZOSIN","1 MG","","Select","Select",""],["","","DULOXETINE","20 MG","","Select","Select",""],["","","AUVELITY","","","Select","Select",""],["","","VILAZODONE HCL","","","Select","Select",""],["","","Ciclopirox 8 % Top Sol Padagis","","","Select","Select",""],["","","Premarin","","","Select","Select",""],["","","DESVENLAFAXINE SUCC","25 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","FLUOXETINE","20 MG","","Select","Select",""],["","","OXYCODONE HCL\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","FLUARIX","","","Select","Select",""],["","","QUETIAPINE","25 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","Cromolyn 4 % Ophth Sol Sandoz","","","Select","Select",""],["","","VRAYLAR","","","Select","Select",""],["","","Ciclopirox 8 % Top Sol Acella","","","Select","Select",""],["","","CICLOPIROX","0.08","","Select","Select",""],["","","ECONAZOLE","0.01","","Select","Select",""],["","","CROMOLYN","0.04","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}