{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cynthia Sheldon","gend":1,"currentgend":"","add":"35 TALLMAN RD","city":"Woolwich","state":"ME","zip":"04579","dob":"1946-12-01","age":"","mstatus":"","insh":"10000017381","cliId":"","pno":2073196692,"cno":2073196692,"email":"wwsheldon@comcast.net","ename":"","eno":"","pphy":"DECK, MARCUS M","ppno":2077984400,"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 84","madd2":"","madd3":"","mcity":"Woolwich","mstate":"ME","mzip":"04579","pcpfaxno":2077984018,"pcpnpi":1891717872,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7G85AG0YQ89","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":["Z13228","E785","C8233","R0609","H2511","H2181","I340","Z950","H353221","H353231","H2589","I2720","I10","M180","Z1231","K219","Z515","R110","K222","K2960","K2980","K449","R12","R1310","Z8572","H353114","H353122","K2970","C8510","R109","I82402","Z23","C8590","K7689","K5730","C8290","R197","D3132","H04123","S61002A","I82491","Z1159","I517","C8230","C73","Z0101","H353220","K668","M8580","M799","R935","H353213","S61112A","I083","S6992XA","I5030","E876","E8342","H353211","K259","D729","R0600","I2510","S6991XA","K635","Z86010","K2080","R053","U071","R5381","R059"],"date":["2024-06-25","2025-06-02","2025-08-07","2025-07-01","2023-12-20","2023-12-20","2025-07-10","2025-09-03","2025-10-30","2025-10-30","2023-12-20","2025-08-19","2025-10-07","2025-06-03","2025-11-06","2024-09-12","2024-09-12","2025-08-07","2024-11-18","2024-08-15","2024-08-15","2024-08-15","2024-07-16","2024-07-16","2024-07-16","2024-11-14","2024-11-14","2024-11-18","2024-11-18","2024-01-10","2023-07-13","2024-10-15","2024-09-03","2024-09-03","2024-09-03","2025-07-31","2024-07-27","2023-11-09","2025-04-23","2024-10-11","2025-04-03","2024-06-25","2024-01-29","2023-07-24","2024-01-19","2025-06-26","2024-04-09","2023-07-24","2025-08-01","2023-07-24","2023-07-24","2024-04-09","2024-10-11","2025-07-01","2025-06-03","2025-07-01","2024-08-09","2024-08-09","2025-11-14","2024-08-15","2024-07-26","2025-08-07","2025-02-07","2025-06-03","2022-09-12","2022-09-12","2022-09-12","2022-09-26","2022-08-28","2022-08-28","2022-08-28"],"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":[["","","JARDIANCE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FAMOTIDINE","","","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":""}]}]}