{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diana J Slowinski","gend":1,"currentgend":"","add":"23 NORTHEAST LN","city":"South Portland","state":"ME","zip":"04106","dob":"1946-03-22","age":"","mstatus":"","insh":"10000042486","cliId":"","pno":2077676382,"cno":"","email":"declined@100125.com","ename":"","eno":"","pphy":"NORMAN, ANASTASIA R","ppno":"","pcpadd":"96 OCEAN ST STE 4,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062855","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"23 NORTHEAST LN","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":"","pcpnpi":1073833703,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9FC4G15GT64","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":["N200","N390","R309","R7303","N281","Z0100","M170","D492","Z23","R350","R300","L400","L03116","Z0000","I10","E781","M79641","M79642","D225","L578","M109","U071","R2689","M13841","M13842","L409","M7989","Z0389","R197","K219","R4182","M48061","D2262","S81832A","W260XXA","Y92009","M6281","R600","Z136","R29898","R2242","M5136","K760","Z13228","Z466","M1711","M180","E119","R3915","L309"],"date":["2025-11-13","2025-11-03","2024-05-29","2025-09-03","2025-03-31","2025-08-11","2024-08-29","2025-01-22","2024-09-09","2025-11-03","2025-11-03","2023-10-16","2024-09-04","2025-09-03","2025-09-03","2025-09-03","2023-03-09","2023-03-09","2023-10-16","2023-10-16","2024-02-19","2024-08-13","2024-08-14","2023-03-09","2023-03-09","2023-03-09","2024-08-12","2024-08-12","2024-08-20","2024-06-05","2024-06-05","2024-08-12","2025-01-22","2024-06-29","2024-06-29","2024-06-29","2024-08-12","2024-08-12","2025-08-21","2024-08-29","2024-08-29","2024-08-29","2024-01-03","2025-08-21","2024-06-05","2024-08-12","2022-11-14","2022-09-14","2022-09-14","2022-09-14"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","PRIORIX","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","OTEZLA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AMPICILLIN TRIHYDRATE","","","Select","Select",""],["","","METHENAMINE HIPPURATE","","","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":""}]}]}