{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maryellen F Carew","gend":1,"currentgend":"","add":"5 ROOS HILL DRIVE","city":"FREEPORT","state":"ME","zip":"04032","dob":"1948-03-23","age":"","mstatus":"","insh":"10000046912","cliId":"","pno":2076323479,"cno":"","email":"maryellen.carew@att.net","ename":"","eno":"","pphy":"MARTIN, STEPHEN","ppno":2078469013,"pcpadd":"Intermed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 157","madd2":"","madd3":"","mcity":"FREEPORT","mstate":"ME","mzip":"04032","pcpfaxno":2078741483,"pcpnpi":1740249861,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9RW0VV9VT29","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I214","Z0001","L602","Q845","B353","E871","I2510","E7800","I10","G603","L858","M79672","M79671","Z0000","E039","E785","M810","K219","I25110","B351","Z85828","Z872","L821","L719","R0789","M549","R0602","K2289","M6281","M8580","S46111D","C44320","L570","K130","R413","R079","Z23","S4991XA","R21","L819","M8588","R4789","R918","N9089","K635","K2970","K649","K449","C44329","F439","M7989","W19XXXA","H2513","R300","K2100","Z0101","L308","S46111A","M12811","S4991XD","I781","I200","F419","M1812","L309","D489","M79645","Z1231","M180","M654","Z1211","M19049","M79644","K224","Z9109","M19041","R457","M40209","R931","Z955","L292","R7309","I080","L900","I252","R0981","H903","H9313","H6981","J342","L814","H6691","R6889"],"date":["2024-09-04","2024-08-14","2024-03-22","2024-03-22","2024-03-22","2025-08-14","2025-07-22","2025-07-22","2025-07-22","2025-09-10","2025-03-26","2025-09-10","2025-09-10","2025-08-21","2025-09-12","2025-08-14","2025-08-14","2025-08-14","2024-05-07","2025-09-10","2025-02-04","2023-03-28","2023-03-28","2023-12-07","2024-05-16","2024-05-15","2024-05-15","2024-08-23","2023-11-15","2023-11-15","2025-06-24","2025-03-17","2025-04-08","2023-06-23","2025-06-23","2024-09-25","2025-08-21","2025-03-18","2023-12-07","2023-12-07","2024-05-22","2024-05-21","2025-04-04","2025-04-01","2025-10-14","2025-10-14","2025-10-14","2025-10-14","2025-02-04","2025-06-23","2025-03-17","2025-03-17","2025-04-16","2024-07-09","2025-10-14","2024-08-21","2024-04-24","2025-03-25","2025-03-25","2025-03-25","2023-12-28","2024-05-15","2024-05-15","2025-08-01","2023-12-07","2025-02-04","2025-08-01","2023-01-21","2025-08-01","2025-07-21","2025-10-14","2025-07-21","2025-08-01","2024-08-23","2024-04-24","2025-08-01","2024-12-31","2024-04-24","2024-05-07","2024-09-25","2025-07-30","2023-06-23","2024-05-07","2025-07-30","2024-09-25","2022-11-10","2022-11-10","2022-11-10","2022-10-11","2022-10-11","2022-08-23","2022-06-16","2022-04-13"],"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":[["","","SHINGRIX","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":""}]}]}