{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Penelope W Curtis","gend":1,"currentgend":"","add":"6 SCRIBNER LN","city":"TOPSHAM","state":"ME","zip":"04086","dob":"1948-09-23","age":"","mstatus":"","insh":"10000027278","cliId":"","pno":2072663162,"cno":2072663162,"email":"penny.curtis48@gmail.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":"6 SCRIBNER LN","madd2":"","madd3":"","mcity":"TOPSHAM","mstate":"ME","mzip":"04086","pcpfaxno":2077984018,"pcpnpi":1922031657,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5AV5J44CM54","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":["M4854XD","M1612","E785","E538","E039","M67432","M25552","R262","I2699","M549","G5602","M25511","Z96642","M5450","M25532","I083","L259","H35372","R531","H35342","Z471","I5040","I2720","S22060D","M8000XD","G5622","M19011","M160","Z1231","R0602","M8580","Z79899","I2609","K449","K5790","K5900","K429","Z1211","K5520","Q438","M79605","M47814","Z0184","R2232","R4182","I82551","C44722","R5383","L570","L218","L819","D229","H5021","H35373","H43813","S22060A","M8000XA","R6889","I5030","H35371","I3481","I2510","R0609","I771","M5134","M5124","U071","Z13228","H04123","H5022","E0500","L219","R011","Z8781","M8589","J189","I080","M546","D492","Z87891","H33009","R21","L719","I358","H5213","H52223","H532","R112","Z98890","L820","L538","Z789","L821","D225","L814","L298"],"date":["2024-01-03","2023-10-05","2025-08-28","2024-08-22","2025-11-04","2024-04-18","2023-06-09","2023-06-09","2025-07-29","2023-11-09","2024-04-30","2025-02-03","2023-11-14","2025-07-31","2023-11-07","2025-04-06","2025-10-28","2024-05-29","2024-11-07","2024-09-30","2023-11-14","2025-04-06","2025-04-06","2024-06-10","2024-01-03","2024-04-18","2025-06-03","2023-07-18","2025-11-04","2025-04-06","2025-08-28","2025-08-28","2025-04-06","2023-11-09","2023-11-09","2023-11-09","2023-11-09","2024-02-26","2024-02-26","2024-02-26","2023-11-09","2023-11-14","2025-04-14","2024-04-18","2024-04-18","2025-04-06","2025-10-09","2023-04-12","2023-08-23","2023-08-23","2023-08-23","2024-09-04","2024-09-30","2024-05-13","2024-05-13","2023-12-09","2023-11-29","2023-05-08","2024-10-08","2024-06-06","2025-04-05","2025-04-05","2025-04-05","2025-04-05","2023-11-25","2023-11-25","2023-06-18","2023-08-17","2023-04-07","2023-04-07","2023-04-07","2024-09-04","2023-08-29","2023-11-29","2024-02-19","2025-03-09","2023-08-29","2023-11-09","2025-09-17","2024-04-18","2024-05-29","2023-04-01","2024-09-04","2024-10-08","2022-11-09","2022-11-09","2022-11-09","2022-09-30","2022-09-30","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-30"],"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":[["","","FLUAD 2025-2026","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","METRONIDAZOLE","","","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":""}]}]}