{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marilyn G Noble","gend":1,"currentgend":"","add":"7 QUAKER LN","city":"Portland","state":"ME","zip":"04103","dob":"1935-05-18","age":"","mstatus":"","insh":"10000021815","cliId":"","pno":2072215687,"cno":"","email":"quiltingpastor@gmail.com","ename":"","eno":"","pphy":"HUOT, BRAD R","ppno":2078282402,"pcpadd":"PO BOX 9746,MARTINS POINT HEALTHCARE","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":"7 QUAKER LN","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04103","pcpfaxno":2078282425,"pcpnpi":1891866372,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5NT7R35RK31","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L570","J9611","M779","M2430","M62838","R109","I5189","I350","I080","I509","J849","R4589","N182","E782","Z515","S81801A","J84112","Z79899","R6889","Z7189","Z9981","J9620","R0600","R600","Z525","Z23","M810","H903","H43813","H26493","I2699","H5213","Z5189","E785","H04123","H26492","I519","I358","I10","R609","R0781","B029","J8489","K5730","M5459","M549","L578","Z809","L539","J8410","Z86711","R079","I517","I2692","I083","I2720","J9621","I5030","I82433","I959","I2723","R918","J479"],"date":["2023-04-27","2025-10-28","2023-06-13","2023-06-13","2023-06-13","2024-09-03","2025-01-15","2025-01-15","2025-01-15","2023-11-15","2025-06-18","2025-08-08","2025-11-13","2025-11-13","2025-06-18","2024-06-13","2025-10-28","2025-10-21","2023-12-01","2025-06-18","2023-04-27","2022-12-04","2025-06-18","2024-06-13","2025-06-18","2024-11-07","2025-11-13","2023-07-14","2025-11-11","2024-11-04","2025-10-28","2023-10-30","2023-08-01","2024-10-31","2025-11-11","2025-11-11","2023-11-15","2023-11-06","2024-04-26","2024-04-26","2024-08-19","2023-04-04","2025-04-04","2024-09-10","2023-03-21","2023-03-21","2023-01-05","2023-01-05","2023-03-21","2023-03-21","2023-03-21","2023-03-22","2023-03-22","2022-09-14","2022-09-19","2022-09-19","2022-08-10","2022-08-10","2022-08-10","2022-08-19","2022-08-06","2022-08-06","2022-08-06"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","PIRFENIDONE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MORPHINE SULFATE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","LISINOPRIL","","","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":""}]}]}