{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carole A Disanto","gend":1,"currentgend":"","add":"33 CAMPION RD","city":"Cape Elizabeth","state":"ME","zip":"04107","dob":"1942-07-12","age":"","mstatus":"","insh":"00007781800","cliId":"","pno":2077972418,"cno":"","email":"","ename":"","eno":"","pphy":"KIM, REGINA Y","ppno":2075351340,"pcpadd":"MERCY WEST FALMOUTH PRIMARY CARE,75 GRAY RD","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"04105","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2077972418,"add2":"","add3":"","madd1":"33 CAMPION RD","madd2":"","madd3":"","mcity":"Cape Elizabeth","mstate":"ME","mzip":"04107","pcpfaxno":2075351358,"pcpnpi":1104906155,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6PV6ET2VC85","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D473","N3090","I471","I4720","R008","I4891","K5120","K625","K5732","K2210","K449","K2270","Z1231","R300","N390","R350","Z1159","R928","N289","D75839","Z0100","Z135","I480","Z5181","Z7964","Z0000","R922","K219","Z8711","J45909","F419","K862","N3289","Z8719","J449","E785","R399","R1310","E7800","I10","Z86711","I5032","N321","K5730","K769","Z23","J9601","N3001","J441","N200","K7689","K439","R079","M5450","K5792","J942","R918","Z01818","R69","I25118","K222","I25119","J111","N281","N3000","Z87440","Z87891","I708","R0602","R197","D72829","J189","R109","J1000","J439","Z9181","K5190","R6330","M549","R7989","Z85118","C3490","N179","M810"],"date":["2025-09-05","2023-04-27","2023-05-04","2023-05-04","2023-05-04","2023-05-04","2023-06-12","2023-06-12","2023-06-12","2025-07-09","2025-07-09","2023-08-17","2023-07-03","2025-06-20","2025-08-07","2024-12-30","2024-12-03","2023-07-27","2023-11-25","2024-11-22","2023-08-15","2023-08-15","2025-03-28","2025-09-05","2025-09-05","2025-06-12","2023-07-27","2023-08-17","2023-08-17","2023-08-17","2023-08-17","2023-11-25","2025-06-16","2025-08-28","2024-04-30","2023-08-17","2023-07-05","2024-01-05","2025-03-28","2025-03-28","2023-10-31","2025-03-28","2025-09-18","2025-07-06","2025-07-06","2025-10-27","2024-03-04","2024-07-03","2024-01-31","2024-04-21","2024-04-21","2024-04-21","2024-09-03","2024-09-03","2025-08-28","2024-01-28","2024-01-28","2025-09-10","2024-09-18","2024-03-14","2024-12-02","2024-10-08","2024-04-25","2024-07-05","2024-09-08","2024-06-28","2024-08-14","2024-09-03","2024-01-28","2024-01-28","2024-10-11","2024-04-25","2024-02-21","2024-01-28","2023-04-10","2023-04-10","2023-04-10","2024-01-05","2024-07-05","2024-04-15","2022-09-12","2022-09-12","2022-08-18","2022-07-25"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","COMPRO","","","Select","Select",""],["","","HYDROXYUREA","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","FOSFOMYCIN TROMETHAMINE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","NEOMYCIN SULFATE","","","Select","Select",""],["","","METHENAMINE HIPPURATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}