{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marjorie S Dube","gend":1,"currentgend":"","add":"284 MAIN ST APT 1","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1952-08-05","age":"","mstatus":"","insh":"10000056061","cliId":"","pno":2073108384,"cno":"","email":"msbrkfast52@gmail.com","ename":"","eno":"","pphy":"CROTHERS, DANIEL S","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":"284 MAIN ST APT 1","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":2078282433,"pcpnpi":1336601996,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8P01H89GU94","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":["R7881","G062","R531","G4733","R079","R0602","R791","Z780","R1031","N200","S93402A","J9601","L304","N201","H6122","S81851A","M85852","Z1231","J449","E6689","Z720","I10","E559","E785","R42","R0600","Z87891","L299","R7301","R17","S82892A","B9562","R600","I38","J9602","S92155A","M2142","I358","I50810","I871","I420","Z23","M5442","R059","M48061","M5126","M47816","M4317","M4802","M47812","G061","M4804","R911","A000","N179","I350","H33312","M1712","A4102","M25562","H6123","R051","J441","R0981","S82892D","Z6843","S92102A","M21612","L600","I6523","H40053"],"date":["2023-02-11","2023-02-11","2025-07-06","2025-11-16","2022-12-16","2022-12-16","2022-12-16","2023-05-22","2022-12-15","2022-12-18","2023-09-05","2022-12-24","2022-12-22","2022-12-19","2025-04-17","2025-04-17","2023-05-22","2025-06-17","2025-08-19","2025-08-19","2025-08-19","2023-01-30","2023-01-30","2025-02-03","2025-07-05","2025-07-05","2025-07-05","2025-04-07","2023-07-17","2023-07-17","2023-09-05","2023-02-11","2025-02-03","2022-12-20","2022-12-20","2023-08-09","2023-09-05","2022-12-19","2022-12-19","2022-12-19","2022-12-20","2025-09-23","2025-09-23","2022-12-22","2022-12-21","2022-12-21","2022-12-21","2022-12-21","2022-12-21","2022-12-21","2022-12-21","2022-12-21","2023-10-31","2022-12-25","2022-12-24","2022-12-18","2024-01-19","2024-05-23","2022-12-20","2024-02-08","2023-12-14","2023-12-14","2023-12-14","2023-12-14","2023-09-05","2024-03-28","2023-09-05","2025-09-26","2025-09-26","2025-07-05","2022-08-09"],"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":[["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}