{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jan E Strout","gend":1,"currentgend":"","add":"89 MOUNTAIN VIEW RD","city":"GRAY","state":"ME","zip":"04039","dob":"1948-11-16","age":"","mstatus":"","insh":"10000029011","cliId":"","pno":2078384217,"cno":"","email":"JANLIZBETH1@GMAIL.COM","ename":"","eno":"","pphy":"EDWARDS, STEVEN R","ppno":2077998596,"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":"89 MOUNTAIN VIEW RD","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":2078287850,"pcpnpi":1710177936,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7FP7NA5DP41","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":["L720","M9905","M9903","M9900","M9901","Z01812","R2681","R6889","E039","Z09","Z96642","E785","H02403","Z0101","L570","L602","I70203","R7301","Z08","M1612","I10","E669","Z23","M9904","Z4789","Z471","Z96643","M8580","H02831","H02834","Z96649","H04123","M9908","Z1231","M9902","E6601","M159","C50911","Z853","Z98890","Z85828","L821","D229","H02839","M1611","J45909","L578","Z780","M85832","R739","C44319"],"date":["2024-01-14","2025-09-22","2025-03-18","2025-09-22","2025-09-22","2023-01-03","2024-09-09","2023-05-24","2025-09-22","2024-01-11","2024-01-11","2025-09-22","2023-09-27","2025-11-17","2025-06-06","2025-10-01","2025-10-01","2025-09-22","2025-10-28","2023-01-28","2023-01-25","2023-01-25","2025-09-25","2025-06-23","2023-10-20","2024-01-11","2024-01-11","2023-10-20","2023-04-20","2023-04-20","2023-01-25","2025-11-17","2024-07-15","2025-10-28","2025-09-22","2024-10-23","2024-10-23","2024-10-25","2023-10-17","2023-10-17","2024-06-07","2024-06-07","2024-06-07","2023-09-27","2023-01-25","2023-01-25","2023-06-23","2022-10-19","2022-10-19","2022-09-13","2022-08-23"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","NP THYROID","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ARMOUR THYROID","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":""}]}]}