{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janet R Totman","gend":1,"currentgend":"","add":"234 SEBASCO RD","city":"PHIPPSBURG","state":"ME","zip":"04562","dob":"1955-09-08","age":"","mstatus":"","insh":"00008175500","cliId":"","pno":2073892885,"cno":"","email":"JANTOTMAN@GMAIL.COM","ename":"","eno":"","pphy":"FLORY, ELIZABETH","ppno":2077984400,"pcpadd":"Martins Point Health Care,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2073892885,"add2":"","add3":"","madd1":"234 SEBASCO RD","madd2":"","madd3":"","mcity":"PHIPPSBURG","mstate":"ME","mzip":"04562","pcpfaxno":2077984018,"pcpnpi":1659865970,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2ED1GR2MH17","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":["G8929","M5450","M79606","F17210","R6889","H25813","F1190","K219","Z720","M5001","M438X2","M461","Z01818","Z23","Z4789","M5451","R2689","L209","D229","M25551","H25811","M961","R748","H25812","Z4782","M40209","M5020","F17200","R4182","M4802","K9189","M5416","G9589","Z981","M9900","M9901","M9902","M9903","M47812","M533","M5116","M7910","M48061","M51370","H04123","H524","G959","Z48811","K6389","Z1231","K567","E669","G8918","M40205","F32A","J45909","Z87891","M40204","M50321","M5135","G894","H26493","M5136","M1611","M546","R399","H02403","H02831","H02834","A000","M4310","R200","M47814","M5134","M4804","M549","M4807","M47816","M5125","M4187","M47817","D492","Z9849","M4005","M4030","Z4659","R933","M4185","Z4542","M5021","M5023","M50222","D0439","D2261","M4322","M4324","R928","Z9682","N6489","R921","R92322","H40003","M7061","R202","Z1211","M5030","Z79899","R6339","M419","M5124","G96191","M25521","S59901A","M7989","M5417","S300XXA","S5001XA","M25421","M8580"],"date":["2023-09-07","2023-09-07","2023-09-07","2024-06-11","2023-12-13","2023-08-02","2024-11-28","2025-10-16","2024-11-28","2024-06-11","2024-06-11","2023-02-23","2024-10-30","2025-10-02","2025-05-22","2025-05-22","2025-05-22","2023-10-18","2023-10-18","2025-05-22","2023-08-02","2023-08-09","2025-10-02","2023-08-30","2024-11-30","2025-05-08","2024-06-11","2024-06-11","2024-11-11","2024-06-03","2024-12-12","2024-11-11","2024-06-11","2025-11-12","2024-11-22","2024-11-22","2024-11-22","2024-11-22","2024-09-26","2023-02-06","2023-01-12","2023-01-12","2023-01-12","2025-02-06","2023-04-25","2025-10-29","2025-05-08","2023-09-21","2024-11-15","2025-11-04","2024-11-28","2025-01-09","2024-11-16","2024-11-11","2024-11-11","2023-08-30","2024-04-12","2024-11-11","2024-07-12","2023-09-21","2023-07-01","2025-04-17","2024-02-15","2025-03-10","2024-11-20","2025-01-14","2025-10-16","2025-10-16","2025-10-16","2024-11-30","2023-08-09","2023-08-09","2024-08-29","2024-08-16","2024-08-29","2024-08-16","2024-08-29","2024-08-29","2023-02-22","2024-08-16","2024-08-16","2024-10-30","2023-10-12","2024-12-12","2025-11-12","2024-11-18","2024-11-20","2024-11-28","2024-11-28","2023-07-01","2023-07-01","2023-07-01","2025-02-27","2024-10-30","2024-12-12","2024-12-12","2025-11-12","2024-11-11","2025-11-12","2025-11-12","2025-11-12","2025-04-03","2025-03-10","2025-03-10","2024-03-18","2025-02-06","2024-06-11","2024-11-21","2024-11-23","2022-10-11","2022-10-11","2022-09-15","2022-09-15","2022-09-15","2022-09-09","2022-09-01","2022-09-01","2022-09-01","2022-09-01"],"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":[["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","BUPRENORPHINE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BUPRENORPHINE-NALOXONE","","","Select","Select",""],["","","BELBUCA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OXYMORPHONE HCL ER","","","Select","Select",""],["","","CELECOXIB","","","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":""}]}]}