{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Myra M Bennett","gend":1,"currentgend":"","add":"10 VANBUREN DR","city":"WEST NEWFIELD","state":"ME","zip":"04095","dob":"1950-12-20","age":"","mstatus":"","insh":"10000045603","cliId":"","pno":2076367229,"cno":2072060098,"email":"benmycolt@yahoo.com","ename":"","eno":"","pphy":"NANNICELLI, ANGELEA","ppno":2077998596,"pcpadd":"Martins Point Health Care,153 US Rte 1","pcpcity":"Scarborough","pcpstate":"ME","pcpzip":"04074","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 VANBUREN DR","madd2":"","madd3":"","mcity":"WEST NEWFIELD","mstate":"ME","mzip":"04095","pcpfaxno":2077778800,"pcpnpi":1366253098,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6V90P84PA08","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":["C9000","M4802","Z0101","H524","Z5112","R7989","R5383","K5100","Z860101","K621","Z0000","Z1231","R569","E039","N184","D509","G620","Z5111","D631","H2513","Z136","A000","Z13220","R918","C9001","N2581","Z01818","M8580","R911","H903","D381","R4182","B029","D862","E8352","Z23","R530","G959","N178","G992","C342","J45909","E785","M47812","M79602","D123","Z981","N1830","R197","K5190","H43813","Z86010","H5203","H52223","N179","R3129","B351","L603","M7502","Z85118","M5412","E8720","H6121","D472","Z792","R531","G40909","R059","D801","L600","D638","M159","M7582","R414","Z743","I051","J850","C9002","J4520","D860","R809","R319","D61818","M542","N189","C3491","M6289","J90","R4701","R200","M67814","R600","M1990","M25512","J069","B9789","C3490","U071","K219"],"date":["2025-11-03","2025-08-29","2025-02-05","2025-02-05","2025-10-06","2024-05-09","2024-01-04","2025-05-28","2025-05-28","2025-05-28","2025-01-15","2025-07-18","2025-08-29","2025-01-10","2025-10-30","2025-05-15","2025-05-15","2025-04-10","2025-03-13","2025-07-22","2024-01-04","2022-11-29","2024-01-04","2025-07-25","2025-03-12","2023-05-18","2022-12-30","2023-11-09","2025-07-25","2025-01-28","2025-07-29","2022-11-30","2023-08-10","2022-12-28","2023-02-28","2024-10-31","2023-09-07","2023-01-03","2024-08-08","2023-02-06","2022-11-30","2023-01-03","2023-01-03","2022-12-16","2023-05-09","2023-07-27","2023-02-01","2024-08-20","2024-08-20","2023-10-12","2025-02-05","2023-08-17","2025-02-05","2025-02-05","2022-12-07","2022-12-07","2025-08-13","2025-08-13","2022-12-29","2023-06-13","2023-01-03","2023-02-16","2025-01-15","2025-03-12","2023-09-07","2022-12-01","2022-12-12","2022-12-12","2024-08-06","2025-10-03","2024-04-25","2024-08-07","2022-11-22","2022-11-23","2022-11-23","2022-11-25","2022-11-16","2022-11-24","2022-11-23","2022-11-23","2022-10-24","2022-11-17","2022-11-03","2022-11-08","2022-11-23","2022-11-16","2022-10-26","2022-11-16","2022-11-23","2022-11-08","2022-10-11","2022-10-11","2022-10-19","2022-10-03","2022-09-21","2022-09-21","2022-09-16","2022-08-24","2022-08-24"],"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":[["","","LEVETIRACETAM","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","DARZALEX FASPRO","","","Select","Select",""],["","","VENCLEXTA","","","Select","Select",""],["","","HEMADY","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","REVLIMID","","","Select","Select",""],["","","BORTEZOMIB","","","Select","Select",""],["","","XGEVA","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PREDNISONE","","","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":""}]}]}