{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marilyn H Blinkhorn","gend":1,"currentgend":"","add":"20 HOWARD ST","city":"Portland","state":"ME","zip":"04101","dob":"1946-11-27","age":"","mstatus":"","insh":"10000030156","cliId":"","pno":2077749291,"cno":"","email":"marilynblinkhorn@yahoo.com","ename":"","eno":"","pphy":"KINGMAN, MEAGAN R","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":"20 HOWARD ST","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04101","pcpfaxno":2078282433,"pcpnpi":1477992097,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3Y46G49TR75","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":["K635","L03115","Z860100","K5730","Z1211","F419","I10","C3412","D692","L821","H2512","M79672","B070","Z1231","Z20822","R0982","J029","S61214A","W01198A","S61219D","W009XXA","I341","J449","I6523","R42","K5900","H35363","H2513","H04123","H43813","H2511","R55","I499","R0600","R0989","R7303","E785","C3490","J432","J439","M79671","R6889","R5381","R5383","K219","E871","S51802A","R0602","R918","M810","R4586","Z0100","R82998","H8190","R7309","K529","T8089XA","R112","N390","Z0189","I5181","Z87891","E119","J90","Z124","I471","R008","Z1151","Z01419","L84","M7742","R413","Z0101","Z23","H26493","R1030","Z880","R309"],"date":["2024-12-09","2023-12-04","2024-12-09","2024-12-09","2024-12-09","2025-03-11","2025-10-29","2025-03-11","2023-05-11","2023-05-11","2023-06-27","2025-09-03","2025-09-03","2025-03-24","2024-03-19","2024-03-19","2024-03-19","2024-12-19","2025-06-25","2024-12-21","2024-12-21","2025-03-11","2025-03-11","2023-01-12","2025-10-15","2024-06-24","2023-04-12","2023-08-02","2023-11-06","2023-04-12","2023-06-06","2025-10-16","2025-10-16","2025-10-16","2023-01-12","2025-10-29","2025-10-29","2025-03-10","2024-03-07","2025-10-15","2025-01-23","2023-08-21","2025-09-26","2025-09-26","2023-06-27","2025-10-16","2025-06-25","2025-10-15","2023-07-13","2025-02-25","2023-02-11","2022-12-01","2023-08-23","2023-08-23","2023-08-23","2023-07-31","2023-07-31","2023-07-31","2023-08-01","2024-06-21","2023-08-24","2023-08-24","2023-02-11","2023-02-11","2025-04-14","2023-09-14","2023-09-14","2025-04-14","2025-04-14","2025-01-23","2025-01-23","2024-11-01","2025-03-19","2023-10-31","2025-10-29","2024-06-24","2022-10-27","2022-10-10"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","TELMISARTAN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLOVENT HFA","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}