{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Milaine J Plante","gend":1,"currentgend":"","add":"45 GATEWAY COMMONS DR","city":"GORHAM","state":"ME","zip":"04038","dob":"1947-09-25","age":"","mstatus":"","insh":"10000025945","cliId":"","pno":2078995877,"cno":"","email":"dmplante14@gmail.com","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":2078995877,"add2":"","add3":"","madd1":"45 GATEWAY COMMONS DR","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":2075231135,"pcpnpi":1962962324,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6YV7ER2VR58","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":["D649","R011","D509","Z1231","R6889","H2589","S72002D","Z1211","K5730","I10","G8918","H2511","S72002A","R509","I340","M353","E7800","H2512","W1839XA","Z79899","E8352","Z471","Z96642","G2581","J101","L03114","T50905A","M810","L249","L720","Z23","L578","E611","S79912A","Z0100","M79601","Z860101","A000","M8588","N1832","E559","L570","H2513","H35371"],"date":["2025-09-29","2023-09-28","2025-10-06","2024-12-06","2023-11-19","2023-01-04","2023-05-31","2024-12-05","2024-12-05","2025-07-21","2023-03-17","2023-01-04","2023-03-18","2023-03-17","2025-07-31","2023-03-18","2023-05-16","2023-01-18","2023-03-17","2023-03-17","2025-07-31","2023-05-31","2023-05-31","2023-06-01","2025-02-22","2024-09-02","2025-09-14","2024-10-18","2025-05-06","2025-05-06","2023-06-01","2024-08-21","2025-06-05","2023-03-16","2024-11-12","2025-09-14","2024-12-05","2023-03-24","2024-10-18","2025-09-29","2023-05-16","2024-08-21","2022-11-08","2022-11-08"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}