{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Merwin E Jasper","gend":0,"currentgend":"","add":"760 RIVER RD","city":"Windham","state":"ME","zip":"04062","dob":"1938-11-21","age":"","mstatus":"","insh":"00008407700","cliId":"","pno":2078929295,"cno":"","email":"declined@070623.com","ename":"","eno":"","pphy":"WATTS, JENNIFER L","ppno":2078392559,"pcpadd":"PO BOX 9746,","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":2078929295,"add2":"","add3":"","madd1":"760 RIVER RD","madd2":"","madd3":"","mcity":"Windham","mstate":"ME","mzip":"04062","pcpfaxno":2075231135,"pcpnpi":1679926828,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5DM8A60WU33","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":["I4891","L820","I5033","I2699","H6121","R7303","I340","R918","R0602","N390","S32018A","R339","R569","S76111D","S32019D","I10","K5900","R062","S32010A","S76111A","W19XXXA","I429","I350","I7120","E854","I680","R531","R300","N179","E785","R5383","T83518A","I352","C44519","N2889","Z8781","S299XXA","I959","I2694","L570","I080","L578","H6123","J101","I5042","Z95828","S8991XA","R8290","L814","L821","Z85828","E875","R262","G40909","Z736","I4811","R0781","E871","M4856XA","G4089","G9340","R059","Z7982","C4442","R55","K449","E669","D492","S76101A","Z743","N281","S8001XA","M66861","R410","M47816","M4316","F0280","C9000","Z23","I6523","Z87448","Z4789","R051","Z0101","S32019A","R6889","I77810","I351","N1830","M25561","N200","S0990XA","R4182","I5032","A419","M5450","M24561"],"date":["2025-06-19","2023-05-08","2025-04-21","2025-03-19","2024-04-16","2025-07-11","2023-07-07","2025-03-02","2025-03-03","2025-07-14","2024-07-11","2025-10-30","2025-09-09","2025-10-13","2024-12-11","2025-03-14","2025-01-27","2025-03-02","2024-10-04","2025-03-13","2025-01-21","2023-10-02","2025-01-22","2023-10-02","2025-09-09","2025-09-09","2025-03-12","2024-08-15","2025-03-14","2025-07-11","2024-07-05","2024-01-10","2024-04-01","2022-12-09","2025-01-06","2024-10-04","2024-07-11","2025-03-04","2025-03-02","2024-02-12","2025-03-06","2024-02-12","2025-06-25","2025-03-03","2025-03-22","2025-06-13","2025-01-22","2025-01-22","2024-02-12","2024-02-12","2024-02-12","2023-08-03","2025-03-19","2025-02-11","2025-03-19","2024-12-30","2024-03-05","2024-09-30","2024-10-04","2024-01-12","2025-01-20","2025-02-02","2024-04-01","2022-11-29","2024-01-08","2024-03-05","2025-01-21","2022-11-29","2025-01-23","2025-01-23","2025-01-06","2025-01-17","2025-01-18","2025-07-14","2024-09-06","2024-09-06","2025-09-09","2025-03-03","2024-09-30","2024-01-08","2024-01-08","2025-02-14","2025-02-02","2022-12-12","2024-07-12","2022-12-27","2024-01-09","2025-06-18","2025-03-18","2025-01-17","2025-01-06","2024-07-11","2024-01-12","2025-03-07","2024-01-12","2024-08-07","2025-01-17"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y 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":""}]}]}