{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Darlene Mantis","gend":1,"currentgend":"","add":"30 LARCHWOOD RD","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1949-11-17","age":"","mstatus":"","insh":"10000051928","cliId":"","pno":2075950882,"cno":"","email":"","ename":"","eno":"","pphy":"GREIL, JENNER E","ppno":2078282402,"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":"30 LARCHWOOD RD","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078287850,"pcpnpi":1871748772,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3C61K96EQ07","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":["D123","K648","K5730","Z1211","K7460","K2970","K7469","Z13228","D509","R7989","Z1231","D72829","I2699","Z7901","K635","Z1289","K8020","H40003","Z0100","I7121","I77810","R002","I340","Z86010","K219","K449","H26493","M810","K824","R918","M8589","K7030","Z780","E43","G2581","M79606","Z23","Z0000","M8580","Z148","Z136","Z13220","K7031","R188","K259","R911","K2950","Z0101","D649","R4182","H16142","H2511","H2512","E509","K7681","H2513","J9600","J9601","K7290","J90","J9811","R791","E538","D696","K760","R110","R0600","R630","E639","F341","K5900","K922","R112","R634","D62","R1110","R197","K831","R739","K838","R7309","N3289","Z008","K921","K766"],"date":["2023-08-16","2023-08-16","2023-08-16","2023-08-16","2025-07-29","2024-11-11","2024-12-20","2024-01-16","2025-01-24","2023-06-13","2024-05-23","2025-02-20","2024-07-19","2024-01-18","2023-08-16","2024-01-15","2025-07-14","2025-05-20","2023-04-26","2025-05-06","2024-04-23","2024-04-23","2025-05-06","2024-01-25","2024-05-01","2024-05-01","2023-06-08","2025-02-13","2023-06-13","2024-11-13","2022-11-29","2024-05-01","2022-11-29","2023-07-20","2024-01-23","2023-05-17","2023-10-04","2024-01-23","2024-01-23","2024-07-19","2024-01-16","2024-01-16","2023-04-24","2023-05-22","2024-05-01","2022-12-16","2024-05-01","2025-05-20","2024-05-01","2024-05-01","2025-05-30","2022-10-05","2022-09-14","2022-09-08","2022-09-06","2022-07-14","2022-06-27","2022-06-04","2022-06-04","2022-06-01","2022-06-01","2022-06-02","2022-06-02","2022-06-02","2022-05-26","2022-05-26","2022-05-26","2022-05-16","2022-04-28","2022-04-28","2022-04-28","2022-03-08","2022-02-26","2022-02-26","2022-02-26","2022-03-03","2022-03-03","2022-02-21","2022-02-21","2022-02-24","2022-02-24","2022-02-21","2022-02-23","2022-02-24","2022-02-24"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","PRAMIPEXOLE DIHYDROCHLORIDE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","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":""}]}]}