{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary L Niven","gend":1,"currentgend":"","add":"1 BESSEY SCHOOL DR APT 213","city":"Scarborough","state":"ME","zip":"04074","dob":"1938-05-13","age":"","mstatus":"","insh":"10000043101","cliId":"","pno":2078054307,"cno":"","email":"marnphoenix@gmail.com","ename":"","eno":"","pphy":"OSULLIVAN, SEAN T","ppno":"","pcpadd":"76 High St Fl 1,","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1 BESSEY SCHOOL DR APT 213","madd2":"","madd3":"","mcity":"Scarborough","mstate":"ME","mzip":"04074","pcpfaxno":"","pcpnpi":1285073205,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8G13TV1PQ72","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H57813","H02831","H02834","K449","Z96641","K5900","K838","G43109","R1013","R1319","Z8619","K5909","R42","E039","I3481","I340","M5450","N390","R319","Z87440","M8588","K581","K31A0","H35371","H353132","R300","N3001","R399","M79605","M79604","Z87891","R519","M5136","M47816","R0600","R109","M170","M810","E663","M549","M4686","M5416","M85861","H5202","H5211","H52223","H524","A048","R1010","Z79899","M2569","M25551","Z13228","E538","E559","Z136","Z13220","H35373","H35372","Z98890","R39198","H547","K2950","M85852","Z780","I2510","I252","K2970","K219","H6121","Z7189"],"date":["2024-10-28","2024-10-28","2024-10-28","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2023-10-23","2024-06-18","2024-06-18","2024-06-18","2025-06-27","2025-03-27","2025-03-27","2025-06-24","2025-06-24","2024-09-16","2025-06-10","2025-06-10","2025-06-10","2024-03-18","2024-03-11","2024-05-21","2024-04-22","2025-03-17","2023-01-25","2023-01-25","2025-06-24","2024-06-13","2024-06-13","2025-06-18","2024-06-13","2024-08-20","2024-08-20","2025-06-19","2025-06-30","2024-06-08","2024-06-08","2024-06-08","2024-06-13","2024-08-20","2024-08-20","2024-08-20","2025-03-11","2025-03-11","2025-03-11","2024-10-09","2025-06-27","2025-06-27","2025-06-27","2024-06-13","2023-11-06","2024-09-26","2024-09-26","2023-09-25","2024-09-26","2023-09-25","2024-04-03","2024-12-16","2024-12-16","2022-10-13","2023-10-21","2024-05-21","2024-03-18","2024-03-18","2023-10-21","2023-10-21","2023-06-06","2023-06-06","2022-09-22","2022-09-22"],"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":[["","","DICYCLOMINE HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","MIEBO","","","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":""}]}]}