{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathy Mercer","gend":1,"currentgend":"","add":"19 LEACH RD","city":"Kittery","state":"ME","zip":"03904","dob":"1956-08-12","age":"","mstatus":"","insh":"10000020292","cliId":"","pno":2074392709,"cno":6032050610,"email":"","ename":"","eno":"","pphy":"STARLING, MARCY J","ppno":6034315154,"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":"19 LEACH RD","madd2":"","madd3":"","mcity":"Kittery","mstate":"ME","mzip":"03904","pcpfaxno":2078287850,"pcpnpi":1417994393,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5TQ2MV5AF15","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":["R0609","M7501","M25511","M25611","R293","Z4789","G4733","Z122","M19011","M5412","M47812","M542","Z96611","E785","J449","Z1329","Z23","E119","E042","T8482XA","M7541","T8484XA","G8918","E041","Z1211","M25562","U071","R0902","L738","L720","E662","Z7189","Z0101","Z87891","Z01818","Z130","Z471","M8588","M7918","Z13820","R202","Z09","G5603","G8929","J9612","M2578","M7532","M9971"],"date":["2025-02-19","2024-04-29","2023-12-13","2023-11-08","2023-12-13","2023-12-13","2025-11-08","2025-06-02","2023-10-05","2023-04-11","2023-04-11","2023-04-11","2023-11-14","2025-05-29","2025-10-24","2025-05-29","2025-10-09","2025-10-02","2024-01-31","2023-09-25","2023-09-25","2023-09-25","2023-11-14","2024-01-19","2023-06-20","2024-07-17","2023-02-06","2025-08-25","2024-07-17","2024-07-17","2025-08-25","2023-06-14","2025-03-04","2025-06-02","2024-06-10","2025-05-29","2023-09-26","2022-11-10","2022-11-08","2022-11-10","2022-11-01","2022-09-13","2022-09-27","2022-09-27","2022-08-09","2022-07-05","2022-07-05","2022-07-05"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","MELOXICAM","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}