{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Geraldine S Dongo","gend":1,"currentgend":"","add":"151 ALLEN AVE APT 183","city":"Portland","state":"ME","zip":"04103","dob":"1939-09-01","age":"","mstatus":"","insh":"10000009828","cliId":"","pno":"","cno":2074096842,"email":"GDONGO1@MAINE.RR.COM","ename":"","eno":"","pphy":"KATZ, JAMES A","ppno":2077711717,"pcpadd":"144 STATE ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41013776","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"151 ALLEN AVE APT 183","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04103","pcpfaxno":2077711727,"pcpnpi":1588605604,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9RT1XV3VW39","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":["E079","Z1231","M9901","M5412","M9902","M9903","E785","Z780","M546","G8929","M419","M9905","M9904","M9900","H903","E039","Z0000","R6889","H4043X1","H9312","H01003","H01006","Z0389","Z23","Z0101","H9122","H9042","M9908","H9193","M25511","F4321","M75101","M19011","M7521","M7052","H109","H6121","H01004","G4700"],"date":["2025-11-11","2025-06-06","2025-11-18","2025-11-18","2025-11-18","2025-11-18","2025-11-11","2025-11-11","2025-10-31","2025-10-31","2025-10-31","2025-10-31","2025-10-31","2025-10-31","2025-10-24","2025-04-30","2023-11-10","2023-05-25","2025-11-05","2025-09-10","2025-11-05","2025-11-05","2025-09-24","2025-05-07","2025-07-07","2025-09-18","2025-09-24","2025-09-22","2025-08-29","2025-05-07","2023-03-07","2025-01-16","2025-01-16","2025-01-16","2025-02-19","2023-08-10","2023-08-10","2023-09-12","2022-10-27"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}