{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joan E Carpenter","gend":1,"currentgend":"","add":"406 MAIN ST","city":"SPRINGVALE","state":"ME","zip":"04083","dob":"1942-08-16","age":"","mstatus":"","insh":"10000032642","cliId":"","pno":2073498197,"cno":"","email":"weeksdragonfly@yahoo.com","ename":"","eno":"","pphy":"WATTS, JENNIFER L","ppno":2078392559,"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":"406 MAIN ST","madd2":"","madd3":"","mcity":"SPRINGVALE","mstate":"ME","mzip":"04083","pcpfaxno":2075231135,"pcpnpi":1679926828,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5KU2KX3HJ81","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I480","G903","N179","I2510","I4891","S129XXD","S129XXA","S22060A","S2241XA","J90","Z743","S12690D","S22068D","I10","R069","M549","K200","D6869","M1611","Z7901","E785","S22008A","R1310","K449","N859","R112","Z23","Z8781","N1830","R5383","R0609","S22060D","S12691D","S199XXA","S0990XA","S22000D","S12690A","E038","M50322","M4312","M810","M4854XA","I4710","R0602","S12600D","N390","Z0101","S3991XA","S3993XA","S2231XA","N882","N950","D251","N8500","D219","Z955","H903","M40204","N858"],"date":["2025-06-04","2024-05-19","2025-09-08","2025-06-04","2024-05-28","2024-05-28","2024-05-19","2024-05-14","2024-05-12","2024-05-12","2024-05-12","2024-05-28","2024-05-28","2025-06-04","2024-05-12","2024-05-12","2024-12-31","2024-11-01","2024-11-01","2024-11-20","2025-06-23","2024-05-19","2024-12-31","2024-12-31","2025-01-16","2024-12-02","2023-03-24","2024-08-15","2025-07-31","2025-08-08","2025-04-25","2024-08-15","2024-08-15","2024-05-12","2024-05-12","2024-05-12","2024-05-12","2025-06-23","2024-08-15","2024-08-15","2025-06-23","2024-08-15","2025-03-18","2024-05-12","2024-05-13","2025-08-08","2024-08-05","2024-04-23","2024-04-23","2024-04-23","2025-04-17","2025-04-17","2025-04-17","2025-04-17","2025-04-17","2024-11-20","2024-06-13","2024-06-07","2025-01-16"],"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":[["","","NITROGLYCERIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","MORPHINE SULFATE","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","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":""}]}]}