{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ellen H Decotiis","gend":1,"currentgend":"","add":"PO BOX 608","city":"BAR MILLS","state":"ME","zip":"04004","dob":"1952-02-25","age":"","mstatus":"","insh":"10000054308","cliId":"","pno":2078099496,"cno":"","email":"ehdecotiis1@hotmail.com","ename":"","eno":"","pphy":"CLARK, SHERI","ppno":"","pcpadd":"Martins Point Health Care,153 US Rte 1","pcpcity":"Scarborough","pcpstate":"ME","pcpzip":"04074","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 608","madd2":"","madd3":"","mcity":"BAR MILLS","mstate":"ME","mzip":"04004","pcpfaxno":"","pcpnpi":1821095241,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9W54XW3NT08","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":["H25812","Z96641","Z131","Z13228","E210","R3129","H8112","R2689","F321","Z600","Z635","Z1231","R102","E041","Z23","H25811","R42","Z0101","H524","M67853","Z0000","F4323","L718","L309","L821","D1801","R922","E042","R7303","N3946","E669","H35371","H43813","H16223","R6889","H8110","L814","R3121","K7689","N3941","R3981","M7601","Z96643","Z85828","Z13220","R928","C451"],"date":["2024-08-20","2025-10-31","2025-07-25","2025-07-25","2025-07-25","2024-06-04","2025-08-06","2025-08-06","2025-09-18","2025-09-18","2025-09-18","2025-09-08","2024-06-15","2024-05-30","2025-07-30","2024-08-13","2024-10-25","2025-11-04","2025-11-04","2025-10-31","2023-08-14","2023-08-14","2024-12-19","2024-12-19","2024-12-19","2024-12-19","2023-09-22","2024-12-03","2023-10-31","2024-06-04","2023-10-18","2024-06-10","2024-06-10","2024-06-10","2023-11-21","2024-09-23","2023-12-27","2024-05-17","2024-06-15","2024-07-09","2024-05-03","2025-11-04","2025-11-04","2022-12-21","2023-08-28","2023-09-22","2024-05-03"],"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":[["","","SERTRALINE HCL","","","Select","Select",""],["","","TOLTERODINE TARTRATE ER","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","MIRABEGRON ER","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ALPRAZOLAM","","","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":""}]}]}