{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anniece E Pardue","gend":1,"currentgend":"","add":"13A PEJEPSCOT TER","city":"Brunswick","state":"ME","zip":"04011","dob":"1936-01-16","age":"","mstatus":"","insh":"10000033937","cliId":"","pno":4083935822,"cno":"","email":"annie.pardue@gmail.com","ename":"","eno":"","pphy":"POULIN, SAMUEL J","ppno":2078282402,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"13A PEJEPSCOT TER","madd2":"","madd3":"","mcity":"Brunswick","mstate":"ME","mzip":"04011","pcpfaxno":2078282433,"pcpnpi":1841827003,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7N24DF9XG76","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":["R079","I4819","R202","M5431","M79604","M1711","Z96652","Z7901","I4820","I10","E785","N289","I4891","R002","E8342","Z23","G609","R911","I700","I2510","S300XXA","I480","D649","M179","R739","M25562","R233","M8589","M810","I3481","Z4802","D692","I4811","R918","D225","L814","L821","L568","I499","G64","N898","Z1231","J449","R531","I517","E612","Z87891","K8020","N189","I129","R0789","Z13820","R058","L570","J479","R0989","R059","M1712","Z13228","Z0101","H5201","H52223","H524","Z961","H0288A","H0288B","L989","R9389","H04123","G5601","E559","M1990","M11261","I471"],"date":["2025-01-24","2024-12-04","2025-10-02","2023-01-10","2023-01-10","2025-09-22","2025-07-30","2025-01-24","2024-06-04","2025-06-07","2024-12-04","2022-12-09","2025-06-07","2024-06-02","2024-06-02","2025-09-16","2024-01-16","2025-09-08","2025-03-07","2025-09-08","2025-05-10","2025-01-24","2025-07-31","2023-11-29","2024-12-04","2025-07-30","2024-06-12","2024-03-27","2024-03-27","2025-01-24","2024-06-20","2024-06-13","2025-10-23","2025-10-29","2025-10-16","2025-10-16","2025-10-16","2025-10-16","2024-06-03","2023-01-12","2024-06-13","2025-01-30","2025-06-07","2025-06-07","2025-06-07","2024-02-13","2025-01-24","2025-09-08","2025-01-23","2025-01-23","2024-02-20","2024-03-27","2025-08-21","2023-10-23","2025-10-29","2025-08-21","2025-08-21","2025-07-30","2023-01-04","2025-03-06","2025-03-06","2025-03-06","2025-03-06","2025-03-06","2023-02-09","2023-02-09","2024-06-13","2025-06-18","2025-03-06","2023-11-27","2022-11-11","2022-11-22","2022-11-22","2022-11-11"],"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",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TELMISARTAN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DILTIAZEM HCL","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","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":""}]}]}