{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karenellen M Smith","gend":1,"currentgend":"","add":"80 QUEBEC ST","city":"Portland","state":"ME","zip":"04101","dob":"1943-12-22","age":"","mstatus":"","insh":"00007602800","cliId":"","pno":2072326413,"cno":2077742727,"email":"kesmith328@gmail.com","ename":"","eno":"","pphy":"HUOT, BRAD R","ppno":2078282402,"pcpadd":"PO BOX 9746,MARTINS POINT HEALTHCARE","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"80 QUEBEC ST","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04101","pcpfaxno":2078282425,"pcpnpi":1891866372,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5R44CE0CQ04","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":["E7800","H4312","H353132","E1169","M810","L900","H903","T8529XD","H35372","H59812","H35352","L292","N952","M79605","H9122","H353211","Z23","S299XXA","Z98890","E119","H409","E118","M2042","M2041","M79674","M79675","N905","S2241XA","T8522XA","Z1389","K1379","R5383","N904","H3342","H90A31","H40013","H2513","H35361","T8529XA","N898","H9011","Z0101","H43811","K862","H33009","N958","H9042","K869","K838"],"date":["2025-10-13","2024-06-12","2024-09-10","2025-10-13","2025-10-13","2025-09-04","2025-08-19","2025-04-30","2025-04-04","2024-12-13","2025-10-23","2025-09-04","2025-03-06","2025-05-16","2023-10-11","2025-10-23","2025-11-03","2023-08-23","2024-02-23","2024-06-12","2023-01-12","2025-07-15","2024-04-15","2024-04-15","2024-04-15","2024-04-15","2025-09-04","2023-08-23","2025-04-30","2023-11-02","2025-06-20","2025-07-18","2023-03-21","2023-01-25","2024-02-15","2025-01-23","2023-05-05","2024-10-25","2025-04-11","2023-04-21","2024-03-15","2025-02-20","2023-06-29","2023-12-14","2023-01-25","2023-05-19","2023-11-02","2025-01-25","2023-11-02"],"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":[["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","BRINZOLAMIDE","","","Select","Select",""],["","","BROMFENAC SODIUM","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","CAREONE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRUE METRIX BLOOD GLUCOSE MTR","","","Select","Select",""],["","","SIMBRINZA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","DIFLUPREDNATE","","","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":{"indx":[],"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":""}]}]}