{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Virginia M Snook","gend":1,"currentgend":"","add":"41 WILSON RD","city":"GORHAM","state":"ME","zip":"04038","dob":"1952-12-31","age":"","mstatus":"","insh":"10000057715","cliId":"","pno":2078928051,"cno":2078317296,"email":"vms2856@yahoo.com","ename":"","eno":"","pphy":"ACHILLE, JUSTINE","ppno":2078392559,"pcpadd":"Martins Point Health Care,PO Box 9746","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04104","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"41 WILSON RD","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":2075231135,"pcpnpi":1962962324,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2WD5JE6VG75","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":["Z1231","E039","R928","M51361","M1612","I2510","R300","Z13220","E162","Z136","Z13228","M8580","M7989","M25531","G7000","H43813","E669","Z6834","N6002","N644","Z1211","R92322","N1830","R1031","N6012","R921","M654","H26492","M79605","M5450","N390","N6324","K5730","H02403","H02831","H02834","M51360","M47816","K5792","S5011XA","K449","K439","N281","R17","X58XXXA","R6889"],"date":["2025-11-05","2025-06-16","2025-04-29","2024-12-03","2024-12-03","2025-03-07","2024-03-12","2023-02-20","2023-02-20","2023-02-20","2023-02-20","2023-02-20","2023-06-15","2023-06-15","2025-05-14","2025-07-21","2024-03-05","2024-03-05","2025-11-05","2023-10-20","2025-04-14","2023-10-20","2025-06-16","2025-06-19","2023-04-26","2023-04-26","2023-06-15","2025-05-16","2024-10-15","2024-10-15","2023-02-27","2025-11-05","2025-07-01","2023-02-03","2023-02-03","2023-02-03","2024-10-15","2024-10-15","2025-05-23","2023-06-15","2025-05-23","2025-05-23","2025-05-23","2023-09-13","2023-06-15","2022-11-13"],"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":[["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PYRIDOSTIGMINE BROMIDE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":{"indx":[["","","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}