{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carol Ross","gend":1,"currentgend":"","add":"67 GARY L MAIETTA PKWY UNIT 25","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1937-06-22","age":"","mstatus":"","insh":"00007380800","cliId":"","pno":2076138906,"cno":2072330379,"email":"bunrol@yahoo.com","ename":"","eno":"","pphy":"ZAFAR, NADIA","ppno":2077672174,"pcpadd":"MaineHealth Primary Care Internal Medicine,155 Spurwink Ave","pcpcity":"Cape Elizabeth","pcpstate":"ME","pcpzip":"04107","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"67 GARY L MAIETTA PKWY UNIT 25","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078282433,"pcpnpi":1194302430,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4UX1RR5AX05","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":["K8689","N281","E119","E1165","E1310","M7121","M810","M25561","R42","E0590","R490","D649","R7989","S92351D","M069","M25551","L821","D1801","L814","Z85828","Z79899","R1013","Z1231","M7989","M25571","K589","S0093XA","R1031","R102","N838","R399","H35383","H04123","R5383","H903","K810","K828","R10819","S2020XA","S92351A","S0990XA","Z7984","S92354D","I959","K449","D225","R6889","C44519","K829","N83292","E042","Z794","R2681","R911","R531","U071","S20212A","K2090","Z87891","S92901A","H65492","R079","M79671","K819","R4182","Z23","E785","E673","M1611","D84821","F419","F5104","H9192","Z0000","R197","R3915","E861","E038","M4802","M50221","M4312","S99921A","N289","N952","N814","N9089","R2689","S92354A","R634","D492","N390","H519","R300","N760","N8110","L820","S2020XD","S0990XD","W010XXA","E1140","R944","F17210","K599","R918","B9620","Z1509","R748","L570","B958","B951","N6314","R928","N6489","Z8719","R7303","M47812","K869","M899","R350","F320"],"date":["2024-04-18","2023-12-29","2025-11-04","2025-07-01","2025-04-01","2024-02-28","2025-08-25","2024-07-02","2025-10-28","2023-09-15","2023-10-12","2023-09-06","2023-09-01","2024-09-18","2025-08-25","2024-10-08","2025-08-12","2025-08-12","2025-08-12","2023-08-29","2025-08-25","2023-12-29","2024-03-12","2024-07-13","2024-07-13","2023-12-14","2024-07-13","2024-06-02","2024-06-26","2024-06-02","2024-08-06","2024-12-23","2024-12-23","2024-06-02","2024-03-21","2023-05-29","2023-05-26","2023-05-26","2024-07-16","2024-07-31","2024-07-16","2025-11-04","2024-09-18","2023-05-29","2023-05-29","2025-08-12","2023-01-01","2025-01-22","2023-05-27","2025-03-21","2025-03-21","2024-09-17","2025-11-18","2025-03-21","2024-07-17","2024-07-17","2024-07-13","2025-01-22","2025-01-22","2024-07-13","2025-10-28","2025-09-03","2024-07-31","2023-05-27","2023-05-27","2023-11-14","2023-03-02","2023-03-02","2024-10-08","2023-09-14","2023-09-14","2023-09-14","2023-09-14","2025-02-27","2023-05-26","2024-06-18","2024-09-17","2023-09-24","2023-09-24","2023-09-24","2023-09-24","2024-08-21","2023-05-26","2024-06-18","2024-06-18","2024-06-18","2023-09-24","2024-07-31","2025-10-27","2024-12-20","2024-10-06","2022-12-21","2024-10-06","2024-02-29","2024-02-28","2024-12-20","2024-08-23","2024-08-23","2024-10-08","2024-05-12","2024-05-12","2024-05-12","2024-02-13","2025-03-21","2024-02-11","2024-02-12","2022-09-13","2022-08-30","2022-08-01","2022-08-01","2022-04-14","2022-04-14","2022-04-14","2022-03-29","2022-03-30","2021-10-14","2021-10-20","2021-10-14","2021-11-10","2021-11-03"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","NOVOFINE 32","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","RALOXIFENE HCL","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","SODIUM FLUORIDE","","","Select","Select",""],["","","TERIPARATIDE","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","TRUEPLUS LANCETS","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","TRUE METRIX BLOOD GLUCOSE MTR","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","MICROLET","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(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":""}]}]}