{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Camilla M Burns","gend":1,"currentgend":"","add":"52 FIDDLERS LN","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1934-11-23","age":"","mstatus":"","insh":"10000019108","cliId":"","pno":8638998105,"cno":2078466043,"email":"camieburns@yahoo.com","ename":"","eno":"","pphy":"THOMAS, ANNE L","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":"52 FIDDLERS LN","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2078282433,"pcpnpi":1245494095,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7ER2U92CW19","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":["M65321","S61211A","M65331","M8580","Z0389","R252","E113293","L821","I350","R0602","E785","D649","E119","E7800","I700","I10","Z01818","M4726","M48061","Z981","M25562","M47816","Z23","E1122","M5450","I080","I422","Z952","Z95811","M1712","N1832","L814","D225","D1801","D492","M4317","I081","Z006","Z953","M5031","M47812","R7303","I517","I3481","M5441","M5442","G8929","I3489","D045","I70213","I129","M48062","M5136","M19041","D692","B351","M25551","I87323","R0789","L570","S61231D","E538","E8342","Z48812","J984","M160","M4856XA","Z85828","M5416","Z0100","D485","L578","I6523","I6529","Z20822","N1831","Z01812","R112","K5730","K8020","M549","R945","M4316"],"date":["2023-06-13","2023-03-31","2023-06-13","2024-09-10","2023-11-15","2023-05-30","2024-10-17","2025-04-23","2025-06-17","2023-09-20","2025-11-18","2024-09-17","2024-09-10","2025-06-17","2023-11-15","2025-11-18","2023-09-14","2024-07-31","2024-07-31","2024-07-31","2023-07-21","2025-10-02","2025-10-23","2024-05-21","2024-01-25","2023-10-27","2023-10-27","2023-10-27","2023-09-14","2024-05-21","2024-05-21","2025-04-23","2025-04-23","2025-04-23","2025-04-23","2023-10-31","2023-09-20","2023-09-22","2023-09-20","2023-10-31","2023-10-31","2025-11-18","2023-09-21","2024-10-23","2023-11-14","2023-11-14","2023-10-31","2024-10-23","2023-06-28","2025-02-07","2024-10-22","2024-08-16","2024-07-16","2024-10-22","2024-10-22","2025-02-07","2024-07-18","2023-10-09","2023-10-19","2025-01-20","2023-04-04","2024-09-17","2024-09-17","2023-09-20","2023-09-20","2024-07-18","2023-12-21","2024-05-16","2023-11-08","2023-10-18","2025-01-20","2025-01-20","2022-10-27","2022-10-27","2022-09-19","2022-09-22","2022-09-19","2022-09-07","2022-09-07","2022-09-07","2022-09-07","2022-09-07","2022-09-09"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","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":""}]}]}