{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Evelyn A Murch","gend":1,"currentgend":"","add":"213 CAPE RD","city":"Hollis Center","state":"ME","zip":"04042","dob":"1938-04-15","age":"","mstatus":"","insh":"10000013860","cliId":"","pno":2077104071,"cno":"","email":"REMURCH@ROADRUNNER.COM","ename":"","eno":"","pphy":"WADLAND, WILLIAM R","ppno":2078282402,"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":"PO BOX 228","madd2":"","madd3":"","mcity":"Hollis Center","mstate":"ME","mzip":"04042","pcpfaxno":2078287850,"pcpnpi":1154499002,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6G83AA3GM16","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":["I739","S91001A","L97312","J441","Z87891","J101","R7309","Z23","J9601","R419","R051","J989","I509","I4820","Z7901","R9439","I5032","R0602","L89616","L03213","G309","F0282","L89619","G4483","F22","R531","R410","I110","M25571","M79671","L03115","R079","I5033","N3000","L97409","L98499","I50810","I083","R262","I4891","K922","L539","R102","J90","Z8719","R0902","G8929","M25511","E785","I10","E6601","Z79899","E039","J449","R8290","D72829","I5030","I2510","I2584","I700","F0280","R4182","U071","Z7982","G319","R9089","S91001D","R0603","L89152","L89312","Z7409","A000","J189","E876","T148XXA","E782","M25551","Z96642","R0609","I081","R931","I499"],"date":["2023-09-07","2023-08-04","2023-09-21","2025-08-06","2025-11-03","2025-02-18","2024-01-02","2024-01-05","2025-02-04","2025-07-12","2025-07-28","2025-07-28","2025-07-28","2023-12-13","2025-05-21","2024-07-09","2023-12-13","2025-07-30","2025-03-04","2023-12-28","2025-07-10","2025-07-10","2025-02-24","2025-02-17","2025-07-17","2025-07-30","2024-12-14","2024-07-24","2024-11-07","2024-11-07","2024-11-07","2024-07-10","2024-09-11","2024-06-05","2024-11-05","2024-11-05","2024-06-03","2024-06-03","2024-06-02","2025-05-28","2025-05-28","2025-04-22","2024-12-05","2024-06-01","2025-05-28","2024-07-15","2025-11-03","2025-11-03","2024-09-11","2024-12-14","2024-09-11","2024-12-18","2025-08-06","2024-12-18","2024-09-04","2024-07-18","2024-07-24","2024-07-09","2024-07-09","2024-07-09","2024-07-24","2025-07-30","2024-12-30","2024-12-30","2024-12-14","2024-12-14","2023-06-09","2025-07-29","2025-02-04","2025-02-04","2025-02-04","2023-06-22","2025-08-06","2025-07-29","2023-06-01","2023-05-30","2024-12-14","2024-12-14","2022-10-04","2022-10-04","2022-10-04","2022-10-04"],"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":[["","","XARELTO","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DILT-XR","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LIDOCAINE-PRILOCAINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CARTIA XT","","","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":""}]}]}