{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marsha L Fair","gend":1,"currentgend":"","add":"16 BLODGETT DR","city":"Bar Harbor","state":"ME","zip":"04609","dob":"1950-11-24","age":"","mstatus":"","insh":"10000048589","cliId":"","pno":2074128786,"cno":"","email":"teachmore3@gmail.com","ename":"","eno":"","pphy":"ONO, RODNEY T","ppno":2072885024,"pcpadd":"Cooper Gilmore Health Center,17 Hancock St","pcpcity":"Bar Harbor","pcpstate":"ME","pcpzip":"04609","pcpcounty":"","pcpid":"","pcpname":"COOPER GILMORE HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 834","madd2":"","madd3":"","mcity":"Ellsworth","mstate":"ME","mzip":"04605","pcpfaxno":2072882902,"pcpnpi":1477626802,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8W13UF4WU15","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F3162","S61218A","F314","F411","F3175","D485","C4330","G4733","G4730","N1832","N250","F319","I10","F3130","R079","C439","F32A","R42","M9903","M5417","C44612","C4339","M5416","F3132","F419","M79661","I350","Z5189","H903","E1122","Z85820","L821","L814","Z08","R6889","I509","E875","R109","Z4889","S01501A","E785","R45851","Z743","F310","K8020","M7918","Z713","R140","H353132","H2513","E119","H43813","I129","S70362A","I1310","R0609","L570","L309","M25561","D3613","L989","C434","B351","M79672","M79671","L602","I6529","E1142","Z428","G119","G20","I679","Z1231","L304","Z85828","M79604","R0600","N179","Z0000","E1140","E1165","G4710","R202","M25551","M1711","H8190","G629","C792","H53431","Z8542","Z87891","H04123","R519","H3530","H2512","G3189","Z87820","G35","F4310","F341","Z0130","G609","S060X0S","E559","J329","Z8659","Z9151","I080","Z98890","M9901","M542","H8192","I3481","R942","R2689","Z90710","Z9079","C430","Z4801","C44310","F338","K5900","K5904","N281","K429","Z1211","Z77010","H5319","H5711","I6523","R9431","M6088","G5601","K581","K2100","K760","Z79899","S0006XA","R6881","I130","R7303","E6601","Z23","R000","G4761","R0683","K224","M5410","M533","R5383","I358","R808","C3400","L578","D1801","L709","R809","L708","R1310","M24011","R1032","N1830","E7800"],"date":["2025-09-04","2024-10-01","2024-11-30","2024-11-15","2024-10-23","2025-09-05","2025-07-11","2025-06-25","2024-02-05","2025-08-08","2025-08-08","2025-07-17","2025-06-25","2024-11-20","2023-09-28","2024-03-05","2022-11-03","2023-06-29","2025-09-04","2025-09-04","2024-03-19","2024-09-12","2025-08-07","2024-12-16","2024-10-12","2025-04-10","2025-06-25","2025-07-01","2023-07-10","2025-03-13","2025-06-17","2025-06-17","2025-01-30","2025-06-17","2023-01-01","2025-04-16","2025-04-16","2022-11-04","2023-12-11","2023-12-11","2025-06-25","2024-11-22","2024-11-22","2024-10-17","2022-11-04","2025-09-04","2023-05-12","2023-05-12","2025-06-02","2025-06-02","2025-06-02","2025-06-02","2025-07-03","2025-07-25","2024-01-15","2024-05-08","2023-10-30","2023-10-30","2025-05-22","2024-07-29","2023-01-13","2024-09-12","2023-01-09","2023-01-09","2023-01-09","2023-01-09","2024-05-06","2024-02-29","2023-09-29","2023-09-20","2023-08-07","2024-02-14","2025-08-12","2025-05-08","2025-06-17","2025-04-16","2025-05-21","2023-12-19","2025-07-22","2023-05-24","2025-08-08","2023-12-20","2023-12-06","2025-04-21","2025-04-21","2024-02-14","2024-02-14","2024-03-05","2023-03-07","2024-09-27","2024-09-27","2023-12-27","2022-11-15","2022-11-15","2022-11-15","2023-07-14","2023-07-14","2023-11-09","2022-12-13","2023-01-17","2024-06-18","2024-02-14","2023-05-31","2022-12-05","2023-06-28","2024-11-20","2024-11-20","2025-02-20","2023-10-05","2025-01-15","2025-01-15","2025-03-21","2023-07-19","2023-11-03","2024-02-14","2023-08-24","2023-08-24","2023-08-28","2023-09-28","2023-07-21","2022-11-25","2024-06-23","2024-01-17","2024-06-23","2024-06-23","2025-06-30","2025-08-21","2023-02-13","2023-02-13","2024-05-06","2022-12-29","2025-02-18","2025-07-29","2024-10-10","2023-06-22","2023-06-22","2023-07-18","2025-05-04","2023-06-16","2025-06-09","2024-12-20","2024-12-20","2022-11-09","2024-04-07","2023-03-30","2023-03-30","2024-11-13","2025-07-07","2025-06-16","2023-06-16","2023-02-16","2025-08-08","2025-03-14","2023-05-23","2023-05-23","2025-06-15","2024-12-19","2025-06-17","2024-11-13","2025-06-30","2025-01-10","2022-08-16","2022-08-16"],"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":[["","","SPIRONOLACTONE","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PERPHENAZINE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","DIVALPROEX SODIUM ER","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","TRULANCE","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","BENZTROPINE MESYLATE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","LURASIDONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","DIVALPROEX SODIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","LUBIPROSTONE","","","Select","Select",""],["","","ONETOUCH VERIO REFLECT METER","","","Select","Select",""],["","","ONETOUCH VERIO METER","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}