{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra E Wadas","gend":1,"currentgend":"","add":"236 CONANT ST","city":"Westbrook","state":"ME","zip":"04092","dob":"1943-12-27","age":"","mstatus":"","insh":"10000030130","cliId":"","pno":2077512574,"cno":"","email":"Pnamasan@yahoo.com","ename":"","eno":"","pphy":"DRISCOLL, MEGAN L","ppno":2078392559,"pcpadd":"Martins Point Health Care,575 Main St","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"236 CONANT ST","madd2":"","madd3":"","mcity":"Westbrook","mstate":"ME","mzip":"04092","pcpfaxno":2078287850,"pcpnpi":1265482152,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9EC4PE7DM99","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H8112","R2681","Z23","R1030","G319","S93401A","M79671","I441","I4710","S76011D","M25551","R262","M6281","R3915","N393","Z1231","Z0101","I6782","H6121","Z1389","M720","M25641","M79644","M79641","R9082","R42","Z950","H26493","R4701","I080","I5030","H40003","E7800","N3946","M7601","Z780","M8589","I63233","L821","D1801","Z85828","L578","L820","Z79899","R2990","H02889","L299","H2511","E785","F418","H2512","S93401D","R2232","H2513","S2020XA","W009XXA","D2272","M1611","I471","I4430","I340","H53453","M65342","Z45018","H538","H903","S99911A","H40013","Z0100","H40012","N952","N362","H6123","H9201","M7741","M7742","I499","M25571","F419","R600","Z4689","M65331","M1812"],"date":["2023-10-05","2023-10-05","2025-05-14","2025-05-14","2024-08-27","2023-04-07","2023-06-08","2025-08-13","2025-07-01","2022-12-14","2023-12-12","2022-12-14","2023-05-23","2023-05-23","2023-05-23","2025-09-10","2024-09-12","2024-08-27","2024-11-26","2023-09-26","2024-05-06","2022-12-08","2022-12-08","2022-12-08","2023-09-26","2023-09-26","2025-08-12","2023-11-16","2024-08-28","2024-03-05","2024-03-05","2025-09-25","2025-04-28","2023-06-16","2023-12-12","2025-07-15","2025-07-15","2023-12-20","2024-04-16","2024-04-16","2024-04-16","2024-04-16","2024-04-30","2023-12-20","2024-04-15","2024-04-11","2023-05-01","2023-04-27","2024-08-09","2023-04-27","2023-04-27","2023-06-08","2023-06-05","2023-01-24","2025-02-18","2025-02-18","2024-04-30","2022-10-12","2023-06-21","2023-06-21","2023-06-21","2024-10-23","2024-05-06","2023-11-07","2023-11-01","2023-02-16","2023-02-23","2024-09-20","2022-11-09","2022-11-09","2023-02-14","2023-02-14","2023-02-16","2023-02-16","2025-05-02","2025-05-02","2023-08-07","2023-02-23","2023-04-13","2022-09-21","2022-09-21","2022-09-14","2022-08-16"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","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":""}]}]}