{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Connie B Bryon","gend":1,"currentgend":"","add":"15 EGGEMOGGIN RD","city":"Harpswell","state":"ME","zip":"04079","dob":"1940-08-01","age":"","mstatus":"","insh":"10000037105","cliId":"","pno":2077255576,"cno":"","email":"CBBRYON@GMAIL.COM","ename":"","eno":"","pphy":"FLORY, ELIZABETH","ppno":2077984400,"pcpadd":"Martins Point Health Care,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 EGGEMOGGIN RD","madd2":"","madd3":"","mcity":"Harpswell","mstate":"ME","mzip":"04079","pcpfaxno":2077984018,"pcpnpi":1659865970,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4TN1HH9AH15","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":["K529","Z7901","I4892","Z4789","M25522","G250","R053","M19072","S52122A","R059","H02052","M79672","E785","R079","I517","I77810","R7303","R001","R0982","K219","J3089","R399","R300","Z1231","N1831","L819","S0990XA","F1090","I480","R0789","I10","R918","I2510","I7121","K580","R4189","A000","Z471","Z96622","H538","R519","I499","M21612","M2040","L852","M79674","B351","M79675","L97513","H5000","I483","R011","R4182","H50011","S52122D","Z0101","Z961","E1122","Z23","R195","M7062","I083","Z043","M47812","M4802","S42402D","M2041","R262","K649","H532","D649","N179","R002","M25511","M25552","I38","R9089","I6782","S53105A","S42402S","R197","N3090","G252","S01111A","I4719","G8918","F32A","Z9682","I081","I4710","N390","K5730","K642","L570","D225","L821","D1801","L814","E1165","N1832","Z872","S52132A","I129","I700","I672","B079","H1132","R339","N393","M1612"],"date":["2023-11-13","2024-03-08","2024-03-08","2025-04-30","2025-04-30","2025-10-24","2025-07-18","2024-07-05","2025-02-10","2025-04-23","2025-02-11","2024-07-05","2025-05-27","2024-08-25","2024-12-27","2025-07-14","2025-05-27","2023-08-18","2025-05-22","2025-05-22","2025-05-22","2025-08-28","2025-08-28","2025-07-31","2025-09-25","2025-07-25","2024-07-02","2023-04-10","2025-09-02","2024-12-17","2024-12-17","2024-12-27","2024-12-27","2024-12-27","2024-10-09","2025-02-08","2023-10-12","2025-03-26","2025-03-26","2024-07-02","2024-07-02","2024-08-25","2023-05-01","2023-05-01","2023-05-18","2023-05-01","2023-05-01","2023-05-01","2023-05-01","2024-08-09","2023-05-05","2024-08-09","2024-08-09","2024-08-09","2025-03-26","2025-02-11","2025-02-11","2025-09-29","2023-11-16","2023-01-06","2022-12-19","2023-05-05","2025-02-08","2024-07-02","2024-07-02","2024-12-24","2023-05-18","2023-05-18","2024-04-10","2024-08-05","2024-08-30","2024-08-30","2025-08-26","2024-03-22","2024-03-22","2023-08-18","2025-02-08","2024-03-22","2024-12-21","2024-12-24","2023-11-13","2023-12-14","2023-10-10","2024-07-02","2025-09-02","2024-12-31","2024-12-31","2023-10-11","2025-07-14","2024-10-07","2025-08-28","2023-11-13","2023-11-13","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2023-05-08","2025-09-29","2025-09-29","2024-12-21","2025-08-25","2024-04-05","2025-02-08","2023-02-02","2022-11-07","2022-11-02","2022-11-02","2022-10-05"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PREVALITE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","CHOLESTYRAMINE LIGHT","","","Select","Select",""],["","","PRIMIDONE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":{"indx":[],"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":""}]}]}