{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"June Keefe","gend":1,"currentgend":"","add":"170 BOOTHBY AVENUE","city":"South Portland","state":"ME","zip":"04106","dob":"1946-08-17","age":"","mstatus":"","insh":"10000013493","cliId":"","pno":2077998326,"cno":"","email":"apksr@maine.rr.com","ename":"","eno":"","pphy":"OSULLIVAN, SEAN T","ppno":"","pcpadd":"76 High St Fl 1,","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"170 BOOTHBY AVENUE","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":"","pcpnpi":1285073205,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3QN9TM4JN58","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":["T80211A","C9190","C250","D729","K8689","F339","C9110","I10","R7301","E785","Z8507","Z5111","R911","R6889","R079","C259","R635","R110","G893","G8918","J984","R509","R109","Z452","Z23","K5730","K760","L578","D225","L821","L918","D72820","A419","E876","K219","E669","E8342","G620","R64","R112","E875","K2970","K269","K5750","E278","Z1231","H35341","Z0101","Z95828","R0602","Z7189","R61","Z98890","H35372"],"date":["2024-08-04","2023-10-25","2025-07-17","2023-10-25","2024-04-17","2023-04-24","2025-08-26","2025-11-04","2024-10-30","2025-11-04","2025-08-26","2025-04-08","2025-05-14","2023-12-31","2025-01-10","2025-11-11","2023-10-25","2024-10-08","2025-01-28","2025-01-10","2025-01-13","2025-01-13","2025-01-10","2025-11-11","2023-10-30","2024-11-20","2024-09-25","2023-01-04","2023-01-04","2023-01-04","2023-01-04","2024-04-16","2024-08-05","2024-08-05","2024-05-24","2024-05-24","2024-10-04","2024-10-08","2024-10-08","2024-07-23","2025-11-14","2024-05-01","2024-05-01","2024-04-16","2024-04-16","2023-05-25","2025-10-08","2025-10-08","2024-05-24","2024-11-20","2024-05-23","2023-07-24","2022-08-18","2022-08-18"],"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":[["","","ATENOLOL","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","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":""}]}]}