{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean B Knudsen Dyke","gend":1,"currentgend":"","add":"56 DURHAM RD","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1949-05-09","age":"","mstatus":"","insh":"10000057181","cliId":"","pno":2074064179,"cno":"","email":"declined@090324.com","ename":"","eno":"","pphy":"DECK, MARCUS M","ppno":2077984400,"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":"56 DURHAM RD","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":2077984018,"pcpnpi":1891717872,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5KT5JK3FH89","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":["C50812","Z1211","C50912","M5416","Z23","L821","R928","Z1231","C50512","M9903","M5450","M546","M9901","S52502A","G8918","S52572A","J45909","R4182","Z170","H1131","G43809","Z780","M810","N6489","Z79811","Z0101","M542","M8580","D242","N6459","M1812","Z08","Z853","Z923","D122","L309","N6032","L308","M25552","D492","L940","M9902","Z13228","E7800","R92323","X58XXXA","H04123","W000XXA","N6325","T1490XA","G43909","G319","Z86010","K635","K648","Z803","G250","G43109","Z1239","R6889","Z98890","S52502D","Z13820","Z510","Z91018","Z9109","C50312","E785","M8589","D1801","L814","D225","G43B0","M160","R195","D123"],"date":["2025-03-27","2024-07-22","2023-03-30","2025-10-23","2025-09-02","2024-02-12","2023-03-30","2023-03-01","2025-10-01","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2024-07-24","2024-04-26","2024-04-26","2024-04-26","2024-04-26","2025-10-01","2025-11-07","2025-04-04","2025-09-29","2025-09-29","2024-11-21","2025-06-05","2022-12-01","2025-04-17","2025-06-05","2025-06-12","2025-10-01","2024-04-24","2023-10-12","2025-03-27","2023-10-12","2024-07-22","2025-08-14","2025-06-12","2025-08-11","2025-09-02","2025-08-11","2025-11-03","2023-06-08","2025-01-30","2025-01-30","2025-03-27","2024-04-26","2024-12-11","2024-04-08","2023-03-22","2024-04-05","2024-12-17","2024-12-17","2024-07-22","2024-07-22","2024-07-22","2023-05-23","2025-02-26","2025-02-26","2023-03-30","2023-01-01","2024-06-06","2024-06-06","2023-09-07","2023-06-14","2023-05-05","2023-05-05","2023-10-12","2023-01-20","2023-09-12","2024-02-12","2024-02-12","2024-02-12","2024-12-17","2025-09-02","2022-08-29","2022-08-29"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","LETROZOLE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","TAMOXIFEN CITRATE","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}