{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane A Mcgraves","gend":1,"currentgend":"","add":"10 CARRIAGE RD","city":"Cumberland Foreside","state":"ME","zip":"04110","dob":"1947-04-27","age":"","mstatus":"","insh":"10000025972","cliId":"","pno":2077494681,"cno":"","email":"DECLINED@03062020.COM","ename":"","eno":"","pphy":"HINE, JENNIFER L","ppno":2077984400,"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":"10 CARRIAGE RD","madd2":"","madd3":"","mcity":"Cumberland Foreside","mstate":"ME","mzip":"04110","pcpfaxno":2077984018,"pcpnpi":1922031657,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8QG4PH1XU99","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23","I10","R339","S52532D","H401132","H2513","G309","F0280","R748","K8020","R300","T83011A","N200","N281","S52532A","R4189","F0150","F0390","R413","Z135","S99922A","S79922A","Z1231","W19XXXA","S52592A","M25552","S79912A","D509","K259","K449","N1330","K5730","R195","M25532","S62102D","K253","S79819A","N3289","I2510","E7849","R310","Z13228","Z130","Z136","Z0000","R319","K921","E785","Z1329","I255","K625","S62102A","G301","F02A0","N390","K219","I252","M80032D","Z0101","H5213","H52223","H40053","H40023","R350","E559","K635","K5090","D649","H6123","N179","N3001","S52502A","M19032","S52202A","M8580","S52572A","M1812","Z86010","R3914","S76012A","I6789","S6292XA","R3911","A6920","I129","Z85828","L814","L578","L821"],"date":["2023-09-13","2024-08-05","2025-11-11","2024-02-28","2025-05-21","2024-11-20","2025-10-07","2025-10-07","2024-04-02","2024-04-08","2024-03-21","2024-04-22","2025-05-27","2025-05-27","2024-04-10","2024-09-09","2025-10-07","2024-03-31","2022-12-16","2024-11-20","2024-03-31","2024-03-31","2024-03-05","2024-03-31","2024-03-31","2024-04-10","2024-03-31","2025-01-15","2024-01-19","2024-01-05","2024-02-23","2024-04-08","2024-01-19","2024-04-10","2024-04-10","2024-01-04","2024-03-31","2024-02-23","2024-08-05","2024-08-05","2024-04-08","2025-01-15","2025-01-15","2025-01-15","2023-01-03","2024-04-08","2024-01-05","2024-01-05","2023-11-29","2023-07-27","2024-09-09","2023-12-26","2023-01-10","2023-01-10","2023-11-08","2024-01-05","2024-01-05","2024-05-10","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-11-14","2024-01-09","2024-01-04","2024-01-04","2023-12-13","2025-02-03","2024-02-23","2024-02-29","2023-12-26","2023-12-26","2023-12-26","2023-12-26","2023-12-26","2023-12-26","2024-01-03","2022-12-22","2024-04-02","2023-05-09","2023-12-26","2023-08-17","2022-11-07","2022-11-07","2022-11-18","2022-11-18","2022-11-18","2022-11-18"],"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":[["","","FLUCONAZOLE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","MEMANTINE HCL ER","","","Select","Select",""],["","","FOSINOPRIL SODIUM","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","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":""}]}]}