{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Catherine A Constantinou","gend":1,"currentgend":"","add":"90 NEW RD","city":"Arundel","state":"ME","zip":"04046","dob":"1956-09-10","age":"","mstatus":"","insh":"10000057810","cliId":"","pno":2072867317,"cno":"","email":"","ename":"","eno":"","pphy":"HUOT, BRAD R","ppno":2078282402,"pcpadd":"PO BOX 9746,MARTINS POINT HEALTHCARE","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":"90 NEW RD","madd2":"","madd3":"","mcity":"Arundel","mstate":"ME","mzip":"04046","pcpfaxno":2078282425,"pcpnpi":1891866372,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7YD1D65PJ90","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":["D860","M549","Z13228","D869","R0602","M5450","Z4659","K56609","R109","J4540","J4520","G4733","M5416","E559","B029","I10","M47816","M48061","R5382","I480","Z23","G9589","S76312A","Z09","K253","K3189","Z79899","K219","E669","J45909","R300","R1013","R197","R059","I483","E876","I4892","M797","M8580","Z6831","N6321","N6322","N6325","R079","K259","Z136","I4710","R9389","S060X0A","Z780","R1310","K222","M25552","M7602","F418","R4182","S0993XA","S0990XA","S199XXA","M160","E6601","F331","M85852","Z79631","S76012A","R112","E538","D84821","M1711","D510","Z13220","M8588","N6489","R92323","R918","N6002","K269","K56600","U071","K2970","J8489","J189","Z1231","Z961","M65252","M1612","S76311D","J209","S24114A","Z8709","J849","I3481","I517","I4891","R42","H532","R791","R0609","R002","S9001XA","S9031XA","S99911A","S8291XA","M25571","M7731","M5134","M47814","M150","D6869","I119","M899"],"date":["2025-06-27","2025-06-27","2025-03-28","2025-10-27","2025-06-30","2022-12-27","2025-05-30","2025-05-31","2025-05-30","2025-10-27","2025-10-27","2025-10-27","2023-02-16","2024-08-14","2025-05-16","2025-11-10","2024-08-30","2024-08-30","2025-11-10","2025-11-10","2025-11-10","2024-08-30","2024-01-18","2023-12-14","2023-12-14","2023-12-14","2023-12-22","2025-01-29","2025-01-29","2023-12-14","2025-04-21","2025-02-28","2025-02-28","2023-08-04","2025-06-30","2025-04-29","2025-03-20","2025-11-10","2025-06-27","2025-06-27","2024-12-09","2024-12-09","2024-12-09","2025-04-14","2025-01-29","2025-03-28","2025-04-17","2023-09-29","2025-06-13","2025-11-12","2023-10-19","2023-10-19","2023-11-12","2024-01-18","2024-01-18","2025-01-29","2025-06-13","2025-06-13","2025-06-13","2023-11-14","2023-11-14","2023-08-09","2025-11-12","2024-01-18","2024-01-18","2023-11-04","2025-03-28","2024-07-15","2024-02-28","2023-10-16","2023-10-16","2024-12-18","2024-12-09","2024-12-09","2023-06-28","2024-12-09","2025-01-29","2025-06-01","2023-11-04","2023-10-19","2023-08-14","2023-08-14","2023-08-25","2025-04-10","2024-12-05","2024-12-05","2024-12-05","2023-03-07","2023-09-13","2023-09-13","2024-03-19","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2025-03-19","2025-03-19","2025-03-19","2022-11-08","2022-11-12","2022-11-12","2022-11-08","2022-11-08","2022-11-08","2022-11-06","2022-09-15","2022-08-16","2022-08-16","2022-08-16","2022-08-24"],"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":[["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","XOPENEX HFA","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","OLMESARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE OIL","","","Select","Select",""],["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","LEVALBUTEROL TARTRATE HFA","","","Select","Select",""],["","","LEUCOVORIN CALCIUM","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","FLUTICASONE-VILANTEROL","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","SUCRALFATE","","","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":""}]}]}