{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lorette R Grant","gend":1,"currentgend":"","add":"79 BIRCH ST APT 205","city":"Biddeford","state":"ME","zip":"04005","dob":"1942-08-21","age":"","mstatus":"","insh":"00008789000","cliId":"","pno":2074322626,"cno":"","email":"declined@050525.com","ename":"","eno":"","pphy":"LETELLIER, TERESA","ppno":2072831441,"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":"","add2":"","add3":"","madd1":"79 BIRCH ST APT 205","madd2":"","madd3":"","mcity":"Biddeford","mstate":"ME","mzip":"04005","pcpfaxno":2075231136,"pcpnpi":1629431622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1AM0QR4AU43","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":["E113393","H16223","S72142A","Z743","I739","E11621","R0600","R609","S199XXA","E113293","S72142D","S0990XA","Z7901","I4891","J9601","N179","R9431","I5041","L89622","I080","I083","I501","I5020","I499","E1165","E13621","L97529","I110","S299XXA","L89620","I350","L97512","E559","N3001","R300","Z98890","Z8781","L97513","S3991XA","S3993XA","H6990","R918","Z0101","M1A9XX0","D729","R059","J189","R0609","Z01812","Z01818","I214","I252","Z515","E1149","R195","I701","I708","D62","Z66","I5032","I480","I4589","I493","E119","I2510","R931","I2720","I70235","L97519","I70202","I4940","I517","M19072","S79912A","T148XXA","J810","D649","L89629","M869","G4730","F418","K219","N390","S59901A","E1140","E785","R4182","R0902","S51011A","M8580","I70261","Z739","U071","D509","L89609","E1169","Z89411","M19071","M7989","M79675","I340","E8770","L97521","L97511","Z48812","L821","D225","D1801","L814","J90","R718","W19XXXA","A419","J811","M25552","B351","L570","L97421","L820","R208","I509","L03031","R262","Z736","M79672","I10","K5909","R1032","M542","Z2821","T8189XS","R509","I5021","M722","Z1383","K8689","E278","E1152","I5030","Z8679","M21611","M21612","N8110"],"date":["2024-09-11","2024-09-11","2025-01-14","2025-01-14","2025-10-27","2025-11-13","2025-05-30","2025-05-28","2025-05-21","2024-08-26","2025-03-30","2025-05-21","2023-10-05","2025-06-17","2025-05-30","2025-05-30","2025-05-30","2025-06-01","2025-07-28","2025-07-22","2025-05-28","2025-05-28","2025-05-28","2025-05-28","2024-07-19","2025-04-09","2025-04-09","2025-02-12","2025-05-21","2025-05-29","2025-08-15","2025-11-13","2023-07-31","2023-09-16","2023-09-26","2025-05-04","2025-05-04","2025-10-30","2025-05-21","2025-05-21","2024-06-06","2022-12-20","2024-01-17","2024-08-26","2025-04-03","2024-08-12","2022-12-22","2025-05-22","2025-09-24","2025-05-23","2025-06-08","2025-08-05","2025-05-28","2025-04-07","2024-11-14","2025-08-12","2025-08-12","2025-01-13","2025-01-13","2025-03-03","2024-04-25","2023-08-26","2023-08-26","2025-02-12","2025-06-03","2025-06-02","2025-05-23","2025-10-09","2025-10-30","2025-10-09","2023-08-19","2023-08-19","2025-11-02","2025-01-09","2025-10-27","2022-12-21","2024-09-05","2025-05-08","2025-10-09","2025-10-09","2025-10-30","2025-10-09","2023-08-07","2023-10-05","2025-04-01","2025-01-10","2025-06-01","2025-05-21","2023-10-05","2024-07-19","2025-10-04","2025-03-01","2024-08-12","2024-04-25","2025-10-16","2025-11-17","2025-11-02","2025-10-30","2025-10-30","2024-03-19","2025-10-30","2025-05-30","2025-01-02","2025-11-13","2025-06-08","2023-11-29","2023-11-29","2023-11-29","2023-11-29","2022-12-22","2024-09-13","2025-01-10","2025-10-04","2022-12-25","2023-10-05","2024-09-18","2023-11-29","2025-10-02","2023-11-29","2023-11-29","2025-03-05","2024-12-19","2025-06-06","2025-06-08","2024-09-23","2025-03-03","2023-11-03","2023-11-03","2025-05-21","2023-11-03","2025-11-13","2025-11-02","2025-06-08","2024-04-10","2023-10-26","2025-10-03","2025-10-03","2025-10-04","2025-06-17","2025-11-17","2022-11-02","2022-11-02","2022-09-15"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","SANTYL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","PRASUGREL HCL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","OLOPATADINE HCL","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","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":""}]}]}