{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marguerite J Aube","gend":1,"currentgend":"","add":"178 BRUCE HILL RD","city":"CUMBERLAND CENTER","state":"ME","zip":"04021","dob":"1947-03-15","age":"","mstatus":"","insh":"10000053437","cliId":"","pno":2078295079,"cno":"","email":"MARGUERITE.AUBE@GMAIL.COM","ename":"","eno":"","pphy":"POULIN, SAMUEL J","ppno":2078282402,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"178 BRUCE HILL RD","madd2":"","madd3":"","mcity":"CUMBERLAND CENTER","mstate":"ME","mzip":"04021","pcpfaxno":2078282433,"pcpnpi":1841827003,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2PM0WY9RF32","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":["Z96652","M25662","M25462","M25562","D509","Z23","S90229A","L601","Z471","Z96651","D649","M1712","M8580","E039","H2511","H9190","H2512","D75839","M8589","M1711","C182","K7689","E041","Z862","H4010X4","H401133","A000","L97512","Z1231","H401113","G8918","C189","E785","H10501","Z9049","Z79890","Z79899","Z01818","H401123","Z483","I10","Z7982","H903","K2100","K2950","D122","N200","K8020","N281","M11262","L821","R6889","H2513","L97319","M160","M170","M79645","M13842","S52612A"],"date":["2025-06-12","2025-01-09","2025-01-09","2024-04-25","2025-05-13","2025-11-14","2023-08-28","2023-08-28","2025-06-12","2024-04-25","2025-11-07","2024-10-14","2024-09-24","2025-11-07","2023-02-02","2025-07-17","2023-02-23","2025-02-21","2023-01-12","2023-04-03","2025-05-16","2025-03-14","2025-03-10","2025-05-16","2023-02-23","2025-08-25","2024-10-17","2022-12-12","2024-10-01","2023-02-02","2025-03-25","2025-07-10","2025-11-07","2024-01-11","2025-04-10","2023-04-03","2023-04-03","2024-10-01","2023-02-23","2025-04-11","2025-11-07","2024-10-14","2025-08-25","2025-03-03","2025-03-03","2025-03-03","2025-03-24","2025-03-24","2025-03-24","2024-04-25","2023-11-13","2023-08-10","2022-12-05","2022-11-28","2022-11-09","2022-11-09","2022-08-30","2022-08-30","2022-08-30"],"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":[["","","RHOPRESSA","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","TOBRADEX","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":""}]}]}