{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gail R Shand","gend":1,"currentgend":"","add":"32 BLUEBERRY LN APT 224","city":"FALMOUTH","state":"ME","zip":"04105","dob":"1934-04-20","age":"","mstatus":"","insh":"00007334800","cliId":"","pno":2077813401,"cno":"","email":"jrshand55@gmail.com","ename":"","eno":"","pphy":"ALLISON, BRENDAN","ppno":"","pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2077813401,"add2":"","add3":"","madd1":"32 BLUEBERRY LN APT 224","madd2":"","madd3":"","mcity":"FALMOUTH","mstate":"ME","mzip":"04105","pcpfaxno":"","pcpnpi":1679034136,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4Y73CX5CK03","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":["R2681","H40023","M6281","S7292XS","U071","F0390","R269","F0280","E031","F0393","R600","B351","R262","G8918","E039","S72002A","I10","R945","S72002S","F02B0","M170","R21","Z853","D513","M818","Z471","Z96642","Z0101","S72002D","L03116","S30810A","I872","M80052A","Z66","J9811","S2241XA","S79929A","M79606","W06XXXA","F5101","S199XXA","R194","S0990XA","C50911","S72012A","M810","Z515","S72042D","F330","W19XXXA","S81802D","E559","R748","C50411","Z170","C7951","R300","Z043","R921","R928","S069X9A","S3991XA","S3993XA","M1712","R634","R0781","S299XXA","R319","S8992XA","S7292XA","R296","R531","L24A9","M109","R109","T8149XA","K8020","L309","S80922D","K5909","Z23","L03115","R222","Z98890","M79604","Z85828"],"date":["2023-12-28","2023-09-27","2024-08-28","2023-08-28","2024-03-26","2025-07-23","2024-04-17","2024-04-17","2025-07-23","2025-07-15","2024-10-30","2025-03-07","2025-03-07","2023-02-28","2023-12-11","2023-05-03","2023-04-19","2023-12-27","2023-08-16","2023-08-16","2024-09-04","2024-09-04","2024-09-04","2025-07-23","2025-07-23","2023-05-03","2023-05-03","2023-09-27","2023-04-17","2025-07-15","2023-12-01","2024-10-30","2023-02-28","2023-02-28","2023-02-28","2023-02-28","2023-02-27","2024-12-05","2023-02-27","2024-10-30","2023-12-29","2024-11-13","2023-02-27","2023-07-28","2023-02-27","2023-05-08","2025-06-10","2023-03-03","2024-01-19","2023-12-29","2024-02-02","2023-11-06","2023-12-02","2023-11-28","2023-11-28","2023-11-28","2024-08-13","2024-12-05","2023-07-28","2023-07-28","2023-12-29","2023-12-29","2023-12-29","2024-12-05","2024-08-14","2024-03-06","2023-02-27","2024-06-27","2024-12-05","2024-12-05","2023-12-28","2023-12-28","2023-03-31","2023-04-19","2023-12-02","2023-03-08","2023-12-02","2023-09-27","2023-09-27","2025-07-15","2022-10-13","2022-08-12","2022-09-07","2022-09-07","2022-08-12","2022-08-12"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PRAZOSIN HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","LETROZOLE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","REXULTI","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}