{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gail E Devilleneuve","gend":1,"currentgend":"","add":"22 WAYCROSS WAY","city":"Limerick","state":"ME","zip":"04048","dob":"1947-06-25","age":"","mstatus":"","insh":"10000019389","cliId":"","pno":2072215878,"cno":"","email":"","ename":"","eno":"","pphy":"ACHILLE, JUSTINE","ppno":2078392559,"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":"22 WAYCROSS WAY","madd2":"","madd3":"","mcity":"Limerick","mstate":"ME","mzip":"04048","pcpfaxno":2075231135,"pcpnpi":1962962324,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9WK1GN8AE29","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":["R079","S2241XA","G629","E871","R0781","S299XXA","S52301A","S52201A","I10","Z1231","G4733","S5291XA","K219","R4182","M51379","M47816","M4316","S52331A","S52231A","X58XXXA","Z1211","S5291XD","Z23","Z0100","S42301D","S42201D","R202","C44311","S52201D","L821","L578","Z85828","D492","M48061","M48062","R29898","R300","N390","L570","L820","L219","S3992XA","Z9181","R296","R269","L700","L720","R208","M810","M5450","S52591D","S52291D","M5116","M4726","S52301D","S52601D","R42","Z7982","M5030","M47812","M4312","M542"],"date":["2024-01-07","2024-01-07","2025-11-04","2023-03-21","2025-08-13","2024-06-27","2024-03-19","2024-03-19","2025-10-23","2025-11-06","2024-10-31","2024-08-19","2024-03-19","2024-03-19","2025-06-19","2025-06-19","2025-10-06","2024-03-19","2024-03-19","2024-03-19","2025-09-15","2024-08-19","2024-01-25","2025-11-05","2024-06-12","2024-06-12","2025-11-04","2024-11-05","2024-08-19","2024-05-13","2024-05-13","2024-05-13","2024-08-12","2025-10-06","2025-10-06","2025-06-19","2024-09-13","2023-11-14","2025-06-19","2023-05-15","2023-05-15","2023-01-05","2023-11-28","2023-11-28","2023-11-28","2024-05-13","2025-01-02","2025-01-02","2025-10-23","2023-01-05","2024-05-01","2024-05-01","2025-07-05","2025-07-05","2024-08-19","2024-08-19","2023-02-02","2022-10-25","2022-08-24","2022-08-24","2022-08-24","2022-08-24"],"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":[["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","LYRICA","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}