{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cora P Langevin","gend":1,"currentgend":"","add":"3 TORI LN","city":"GORHAM","state":"ME","zip":"04038","dob":"1951-08-18","age":"","mstatus":"","insh":"10000049607","cliId":"","pno":2072220530,"cno":"","email":"declined@121024.com","ename":"","eno":"","pphy":"WATTS, JENNIFER L","ppno":2078392559,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 TORI LN","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":2075231135,"pcpnpi":1679926828,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8VD8AR7UQ33","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":["Z8551","N3281","R519","R490","R059","I6523","Z1231","Z1211","K621","D120","D122","R0789","I10","I771","J438","Z87891","C674","N3941","M5416","R739","Z961","C672","R070","M5459","M79671","M8589","E785","M810","D225","D2272","D2239","L821","N3000","R300","M25551","R1031","M47816","M160","H2512","Z23","J209","Z0100","J449","E559","S90811A","L03115","X58XXXA","L720","R079","Z720","H2513","F17200","Z7982","K219","Z1152","D485","R202","Z0101","M5451","N390","H2511","M4722","R5383","M7061","M1611","C679"],"date":["2025-05-01","2025-05-01","2025-01-03","2025-05-13","2024-06-24","2025-03-07","2025-10-07","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2024-10-02","2025-11-11","2025-03-07","2025-09-12","2025-09-12","2024-08-27","2024-08-27","2025-04-30","2025-08-22","2023-10-13","2023-01-31","2024-06-24","2025-01-03","2023-10-05","2024-04-07","2025-01-21","2024-08-07","2024-10-08","2024-10-08","2024-10-08","2024-10-08","2023-02-02","2023-09-06","2023-06-06","2023-06-06","2025-03-05","2023-06-06","2023-08-23","2024-09-18","2024-06-24","2024-11-25","2024-02-10","2024-06-17","2023-10-05","2023-10-05","2023-10-05","2023-01-05","2024-08-07","2023-03-28","2023-04-25","2024-08-07","2024-08-07","2025-11-11","2024-02-10","2023-01-12","2024-08-26","2022-12-22","2025-04-22","2023-09-06","2023-08-09","2024-12-06","2022-10-06","2022-09-14","2022-09-14","2022-08-17"],"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":[["","","FLUAD 2025-2026","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","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":""}]}]}