{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna M Sturgis","gend":1,"currentgend":"","add":"7 RAILROAD AVE APT 201","city":"Gorham","state":"ME","zip":"04038","dob":"1947-08-26","age":"","mstatus":"","insh":"10000043726","cliId":"","pno":2078396614,"cno":"","email":"","ename":"","eno":"","pphy":"FAY SHIELDS, JACOB A","ppno":2078392559,"pcpadd":"Martins Point Health Care,575 Main St","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 RAILROAD AVE APT 201","madd2":"","madd3":"","mcity":"Gorham","mstate":"ME","mzip":"04038","pcpfaxno":2075231135,"pcpnpi":1467038042,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4HQ7TN9CQ43","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":["S82842B","S82842A","S92352A","Z4789","I5022","S8991XA","Z01818","S92145A","S82892A","I2510","I10","I25119","H6122","S82892B","S82892D","Z23","S82302B","S82832B","W109XXA","S80912A","S99911A","R413","S8252XD","R7303","E785","N1830","S82832D","S82302D","T84498A","I77810","I5189","M7989","T847XXA","S82892S","T8189XA","Z961","H2522","H5703","H2512","H259","I255","H35371"],"date":["2024-02-10","2024-02-10","2024-02-10","2024-06-04","2025-05-07","2024-02-10","2024-02-10","2024-02-10","2024-05-07","2025-04-30","2025-05-07","2025-05-07","2025-08-26","2024-02-12","2024-09-03","2024-12-05","2024-02-11","2024-02-11","2024-02-11","2024-02-10","2024-02-10","2024-12-03","2024-09-03","2024-04-15","2024-04-15","2024-12-03","2024-06-04","2024-06-04","2024-03-20","2023-12-01","2023-12-01","2024-04-23","2024-03-20","2024-03-20","2024-03-19","2022-10-21","2022-09-12","2022-09-12","2022-09-12","2022-09-12","2022-06-03","2022-05-19"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","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":""}]}]}