{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rosetta A Andrews Symonds","gend":1,"currentgend":"","add":"66 PINE HILL RD","city":"Casco","state":"ME","zip":"04015","dob":"1948-08-16","age":"","mstatus":"","insh":"10000026438","cliId":"","pno":2077762556,"cno":2077762556,"email":"rosieasymonds@gmail.com","ename":"","eno":"","pphy":"ZAGER, SAMUEL","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":"1 WINTERGREEN WAY","madd2":"","madd3":"","mcity":"Steep Falls","mstate":"ME","mzip":"04085","pcpfaxno":2078287850,"pcpnpi":1821383860,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9QP4VV2PR92","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":["I5032","Z23","E039","H26491","H40053","H43813","H04123","G4733","L989","I2510","R002","I10","H61002","M25551","M47896","R262","E782","Z79899","L570","G4719","R0683","R5383","M9903","M5450","M9902","M546","I5030","I340","E785","I110","R059","F325","Z1231","R42","M1712","G4710","R5382","H5213","D492"],"date":["2025-07-16","2023-09-13","2025-11-18","2025-07-02","2025-07-02","2025-07-02","2025-07-02","2025-10-29","2023-02-27","2025-07-16","2023-12-22","2024-11-12","2023-05-17","2023-11-09","2022-12-28","2022-12-28","2025-11-18","2025-04-11","2023-03-02","2025-10-06","2025-10-29","2025-10-06","2024-11-07","2025-04-11","2024-11-07","2024-11-07","2025-08-08","2025-08-08","2025-07-16","2025-07-16","2024-11-19","2024-09-14","2025-01-06","2024-07-18","2024-09-14","2025-10-29","2025-10-29","2025-07-16","2023-03-02"],"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":[["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","NEXLETOL","","","Select","Select",""],["","","REPATHA SYRINGE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","NITRO-BID","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","ADVAIR DISKUS","","","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":""}]}]}