{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John F Dennen","gend":0,"currentgend":"","add":"156 HILDRETH RD","city":"Harpswell","state":"ME","zip":"04079","dob":"1946-07-17","age":"","mstatus":"","insh":"10000012885","cliId":"","pno":2077980824,"cno":"","email":"declined@11052025.com","ename":"","eno":"","pphy":"CARDELLA, AMANDA D","ppno":2077984400,"pcpadd":"Martins Point Health Care,PO Box 9746","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04104","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"156 HILDRETH RD","madd2":"","madd3":"","mcity":"Harpswell","mstate":"ME","mzip":"04079","pcpfaxno":2077984018,"pcpnpi":1902219389,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9Q41VY9EC34","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":["E860","C61","R531","A000","M1712","M1711","K429","M170","E785","R779","I959","R259","Z8546","M179","D649","R771","R399","G4733","Z01818","I5022","Z950","K449","N400","N281","F331","I429","F1021","D801","I2510","Z13228","Z130","E039","Z23","Z0000","I10","Z96652","K436","M25561","Z13220","Z136","R059","R5383","Z08","Z923","M25552","J069","J188","K432","J189","L821","L814","L218","E669","M1612","Z2839","Z471","R195","K2270","K219","M7989","K2090","G8918","R112","Z98890","F418","I4891","I252","Z1211","K5730","K5520","K640","K31819","I420"],"date":["2023-08-31","2025-06-10","2023-09-01","2023-10-12","2023-12-05","2025-03-11","2024-08-14","2023-10-10","2025-06-09","2023-10-09","2023-08-31","2024-10-29","2024-10-29","2023-09-19","2024-02-27","2024-02-27","2025-06-10","2025-02-05","2024-08-13","2023-09-12","2025-09-09","2024-07-31","2024-07-31","2024-07-31","2023-05-02","2023-05-02","2023-05-02","2023-12-06","2023-12-06","2023-12-06","2023-12-06","2024-12-13","2024-12-17","2024-12-17","2023-12-12","2024-01-25","2024-08-14","2025-11-19","2024-12-13","2024-12-13","2024-01-09","2023-02-17","2023-02-15","2023-02-15","2023-02-20","2024-01-08","2024-01-08","2024-10-01","2024-01-09","2024-01-04","2024-01-04","2024-01-04","2022-12-02","2023-02-20","2022-12-06","2023-10-12","2023-05-22","2023-05-22","2023-05-22","2023-10-10","2023-05-22","2023-10-10","2023-10-10","2023-10-10","2024-08-14","2024-08-14","2024-08-14","2023-05-22","2023-05-22","2023-05-22","2023-05-22","2023-05-22","2023-11-08"],"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":[["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CARTIA XT","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","AREXVY","","","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":""}]}]}