{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diana L Holcomb","gend":1,"currentgend":"","add":"5 HUGH AVE","city":"Bailey Island","state":"ME","zip":"04003","dob":"1945-05-06","age":"","mstatus":"","insh":"10000022698","cliId":"","pno":2078336740,"cno":"","email":"","ename":"","eno":"","pphy":"GLASSPOOL, NORA G","ppno":2078731181,"pcpadd":"31 FRONT ST,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49016626","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 HUGH AVE","madd2":"","madd3":"","mcity":"Bailey Island","mstate":"ME","mzip":"04003","pcpfaxno":2078731186,"pcpnpi":1275820250,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3R40NJ5EQ15","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":["R262","M47896","M5416","M87051","R1900","Z90710","N838","I471","R002","C642","D279","N83209","I10","M25552","M5451","Z4732","M6281","M25551","H04123","Z1231","M1612","M25562","M9905","M9903","M9904","Z96641","S73191A","M8580","R509","R1084","K5730","H8110","M79604","I4710","I493","D649","R519","N2889","M9906","N289","Z23","Z961","R42","R112","I6523","Z131","N9489","I2510","E039","E7849","M79651","R001","M129","M25775","M79672","E559","E7800","Z87891","E785","R9089","G459","J329","M160","I878","R0602","R9431","R7401","K7689","Z8541","N6489","R1032","M799","I700","I160","M25561","M25451","M94251","R92331","M47816","M9901","M9902","M9900","M9908","M8588","I517","Z85528","A000","R928","M5116","M4726","M419","R160","Z13220","Z136","R1030","R5381","I082","D271","N83201","Z471","Z98890","H049","R140"],"date":["2025-10-07","2025-10-07","2025-10-07","2023-05-15","2023-09-05","2023-08-15","2023-08-15","2023-04-20","2025-09-18","2025-07-30","2023-10-04","2023-10-04","2025-09-16","2024-07-23","2024-07-23","2023-05-19","2023-05-19","2025-08-20","2025-03-24","2025-09-23","2025-08-20","2025-05-20","2023-07-12","2023-07-12","2023-07-12","2025-09-05","2023-02-07","2025-08-12","2024-07-16","2024-07-06","2024-07-06","2024-04-22","2025-05-05","2025-09-03","2025-09-03","2025-09-18","2024-07-06","2025-06-06","2023-04-19","2023-07-25","2025-09-10","2024-10-23","2024-04-22","2024-04-02","2023-05-02","2025-09-18","2023-10-23","2025-09-16","2025-07-10","2023-03-24","2023-01-19","2023-05-02","2023-08-08","2023-08-08","2023-08-08","2025-07-10","2025-08-11","2023-03-24","2023-10-04","2024-04-02","2024-04-02","2024-04-02","2023-03-23","2023-03-23","2023-03-03","2023-03-03","2024-07-16","2023-05-30","2023-03-23","2025-10-06","2023-07-25","2023-07-25","2023-07-25","2024-04-03","2025-05-05","2023-02-07","2023-02-07","2025-10-06","2025-08-20","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2025-08-14","2025-06-26","2025-06-26","2023-03-26","2025-10-06","2025-06-10","2025-06-10","2025-06-10","2023-05-30","2023-05-10","2023-05-10","2024-07-06","2024-07-06","2025-09-04","2023-10-04","2023-10-04","2023-03-26","2023-10-04","2022-11-16","2022-08-22"],"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":[["","","EZETIMIBE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","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":""}]}]}