{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda R Cappelletti","gend":1,"currentgend":"","add":"75 STATE ST APT 326","city":"PORTLAND","state":"ME","zip":"04101","dob":"1947-05-23","age":"","mstatus":"","insh":"10000021869","cliId":"","pno":2075631699,"cno":2075364099,"email":"","ename":"","eno":"","pphy":"GREIL, JENNER E","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":"211 ROYAL RD","madd2":"","madd3":"","mcity":"POWNAL","mstate":"ME","mzip":"04069","pcpfaxno":2078287850,"pcpnpi":1871748772,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8PX9HH1XP28","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z720","J441","I739","N179","F10239","L03115","U071","I4891","L089","I10","J449","G3184","J4489","D649","R4182","I96","R410","G9340","F1010","J439","S92491A","Z7189","F10930","I6523","I7143","K122","M546","R059","M19071","E1140","E782","B351","R262","F419","Z4801","D509","A0471","R4189","R110","K769","R627","R2241","J09X1","M19072","I480","R630","K5792","I080","R9439","S99921A","W010XXA","F17200","I82409","R600","I824Y9","M9902","M5414","R2243","Z48812","L97519","E785","I70235","I70245","F32A","I7409","I7389","G894","I70263","D62","I7092","M79661","I701","I708","I70203","K529","Z716","I998","D508","R197","F1090","R1011","L259","I2699","K5900","T8189XA","R58","R109","G600","R2689","M869","I70261","G9341","Z515","Z66","Z23","G8929","B0229","Z01818","Z5189","R1084","S98139A","S91104A","Z98890","T8131XS","Z89421","M7022","Z7902","Z7901","K219","Z95820","M25571","J440","R052"],"date":["2025-03-12","2025-03-12","2025-07-28","2023-04-04","2023-04-05","2023-12-22","2023-04-04","2025-07-28","2023-04-09","2025-04-03","2025-07-28","2024-03-13","2024-03-26","2025-04-03","2023-05-24","2023-07-08","2023-04-04","2023-04-20","2023-03-31","2023-05-25","2023-04-03","2023-04-05","2023-03-13","2023-08-09","2023-08-09","2025-01-29","2025-01-17","2023-03-12","2023-03-16","2023-10-06","2023-09-26","2025-01-31","2025-01-31","2023-08-29","2023-08-14","2025-05-19","2025-02-21","2023-05-02","2023-04-19","2023-08-24","2023-08-24","2023-03-12","2025-02-17","2023-03-16","2023-10-06","2023-04-20","2025-03-06","2023-03-15","2023-03-15","2023-03-12","2023-03-12","2025-07-28","2023-12-22","2023-12-22","2023-12-27","2024-11-22","2024-12-23","2023-12-27","2023-06-04","2023-07-12","2025-05-19","2023-06-21","2023-06-21","2023-05-24","2023-05-25","2024-01-08","2024-10-17","2023-05-24","2023-05-25","2023-05-24","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2025-06-19","2025-06-30","2023-07-07","2024-02-16","2024-02-16","2023-04-20","2024-10-11","2023-11-07","2023-11-07","2023-11-07","2023-07-10","2023-07-10","2024-10-11","2023-08-16","2023-08-16","2023-04-12","2023-07-07","2023-04-14","2023-04-14","2023-04-14","2023-05-03","2024-12-23","2024-12-23","2023-07-05","2023-04-20","2024-10-11","2023-07-17","2023-07-10","2023-07-10","2023-07-14","2023-07-14","2023-11-28","2023-07-07","2023-07-07","2023-04-14","2023-07-07","2023-04-18","2024-04-23","2024-07-05"],"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":[["","","LOPERAMIDE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","VANCOMYCIN HCL","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","PROCHLORPERAZINE","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CILOSTAZOL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","DIFICID","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","BETAMETHASONE VALERATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","BUDESONIDE ER","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","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":""}]}]}