{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martha A Resotko","gend":1,"currentgend":"","add":"10 SHEPARD WAY","city":"Gorham","state":"ME","zip":"04038","dob":"1948-06-09","age":"","mstatus":"","insh":"10000026418","cliId":"","pno":2078120070,"cno":2078120070,"email":"mresotko@gmail.com","ename":"","eno":"","pphy":"HEARD CUSHING, KAREN S","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 SHEPARD WAY","madd2":"","madd3":"","mcity":"Gorham","mstate":"ME","mzip":"04038","pcpfaxno":2075238597,"pcpnpi":1720421217,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5GV3UV2NV71","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":["F329","N841","H40013","H04123","H18833","R9389","M7062","M7061","C44529","Z1231","C44311","M1711","M722","L578","R7303","E7800","L570","B079","Z0000","M8588","Z1159","L819","R0981","H9313","R1900","B351","R6889","Z7184","Z1212","Z1211","M25561","J3089","H61893","N838","C4491","C4492","G250","D492","D225","L821","Z85828","M8580","N839","N888","M25522","N950","I8393","M179","L603","M25552","B070","H903","Z23","Z0001","D485","S59902D","M1990","A6920","B0233","E119","S40261A","M65342","Z20822","Z01818","M65332","H26492","R7301","M6258","R32","M170","H938X1","S42252A","M25519","M8589","S42255A","Z13820","M19012","M67814","R102","M25512","S2231XA","S2241XA","S20211A","M533"],"date":["2025-01-06","2025-10-31","2025-05-09","2025-05-09","2025-05-09","2025-11-06","2025-07-11","2025-07-11","2024-01-24","2024-10-02","2024-07-16","2025-08-12","2024-10-30","2024-09-03","2025-05-01","2025-05-01","2025-03-03","2025-09-26","2024-11-07","2024-11-11","2024-11-07","2024-01-02","2025-03-12","2025-04-28","2025-11-06","2025-08-11","2023-10-12","2025-05-21","2024-05-08","2024-05-08","2024-04-12","2025-04-28","2025-04-28","2025-10-13","2024-05-21","2024-01-24","2025-01-27","2024-09-03","2024-09-03","2024-09-03","2024-05-21","2025-05-01","2025-10-21","2025-10-21","2025-05-05","2025-10-10","2022-12-13","2022-12-13","2025-08-11","2023-03-23","2023-11-22","2025-01-10","2025-05-07","2025-05-07","2025-09-26","2025-04-04","2025-04-04","2023-05-04","2023-10-20","2023-10-20","2022-11-08","2022-10-04","2022-10-01","2022-09-21","2022-08-17","2022-06-13","2022-04-11","2022-03-16","2021-10-12","2021-11-04","2021-11-04","2021-11-17","2021-11-16","2021-12-13","2021-11-18","2021-11-17","2021-11-30","2021-11-30","2021-11-10","2021-11-30","2022-01-04","2022-01-04","2021-11-24","2022-02-11"],"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":[["","","ATOVAQUONE-PROGUANIL HCL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","FLUAD QUAD 2021-2022","","","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":""}]}]}