{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elna M Clancy","gend":1,"currentgend":"","add":"257 CANCO RD APT 113","city":"Portland","state":"ME","zip":"04103","dob":"1940-12-06","age":"","mstatus":"","insh":"10000042735","cliId":"","pno":2075360597,"cno":"","email":"elnaclancy@gmail.com","ename":"","eno":"","pphy":"WADLAND, WILLIAM 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":"257 CANCO RD APT 113","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04103","pcpfaxno":2078287850,"pcpnpi":1154499002,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1VH5D29UR40","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":["M549","W1849XA","M48061","M1712","R059","S51812A","S0990XA","S199XXA","S41112A","Z87891","M0689","S59919A","G3184","F331","F419","F430","Z638","A000","S59912A","N390","R300","F330","B351","M79675","M79674","R296","T1490XA","W19XXXA","L821","D1801","L814","Z85828","L820","M810","R748","E876","I10","I361","I517","R42","R531","R609","S4992XA","R519","S299XXA","S3991XA","S3993XA","M25562","Z043","H26491","H04123","H5213","H52203","L603","Z13820","M85852","M1732","M069","D492","D225","M8588","M25552","H02883","H02886","R1310","R269","M0579","R2689","Z23","Z8739"],"date":["2023-05-22","2023-05-22","2025-10-21","2025-09-12","2024-12-13","2024-06-24","2025-09-12","2023-05-22","2024-05-25","2024-05-25","2022-12-18","2024-05-25","2025-08-18","2023-04-04","2023-05-09","2023-04-04","2023-05-09","2023-06-01","2024-05-25","2024-09-14","2024-09-14","2023-05-09","2024-02-02","2024-02-02","2024-02-02","2024-05-29","2023-12-26","2025-09-12","2025-02-19","2025-02-19","2025-02-19","2023-10-18","2025-06-05","2024-10-28","2023-05-24","2023-06-01","2025-09-12","2023-05-24","2023-05-24","2025-08-06","2023-06-19","2025-09-12","2023-05-22","2023-12-27","2023-05-22","2023-05-22","2023-05-22","2025-09-12","2025-09-13","2025-01-28","2025-01-28","2025-01-28","2025-01-28","2023-10-19","2025-03-31","2025-03-31","2023-04-13","2023-04-13","2025-02-19","2025-02-19","2025-03-31","2023-05-22","2023-01-10","2023-01-10","2022-11-04","2022-11-25","2022-11-18","2022-11-04","2022-09-21","2022-09-21"],"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":[["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","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":""}]}]}