{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cheryl A Bennett","gend":1,"currentgend":"","add":"920 E BURROUGH RD","city":"Bowdoin","state":"ME","zip":"04287","dob":"1956-11-10","age":"","mstatus":"","insh":"10000058383","cliId":"","pno":2076663033,"cno":"","email":"BINNBUMP@GMAIL.COM","ename":"","eno":"","pphy":"GARDINER, PAMELA A","ppno":2077984050,"pcpadd":"Martins Point Healthcare,74 Baribeau Dr","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"920 E BURROUGH RD","madd2":"","madd3":"","mcity":"Bowdoin","mstate":"ME","mzip":"04287","pcpfaxno":2078287850,"pcpnpi":1023030020,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9X33XQ4KW99","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":["Z5111","I5030","J449","Z1231","Z515","C3490","J90","J432","I2510","H26493","C3481","C3491","R911","R928","R42","R110","I6782","R9089","R011","I10","J9611","J9612","F325","M159","N6002","R194","M818","C3432","J439","Z95828","R918","Z0101","A000","M19079","M810","Z48813","J929","M8000XA","T80212A","Z85118","Z452","R92332","Z13228","I700","S22060A","S32020A","Z23","Z0001","M8000XD","M4854XA","J329","M546","M549","M439","S22059A","B351","H903"],"date":["2025-02-03","2024-02-08","2025-06-11","2024-10-03","2025-03-26","2025-06-17","2024-09-10","2023-11-20","2024-07-12","2023-06-21","2025-05-21","2025-06-18","2024-09-10","2023-10-02","2024-11-25","2024-11-25","2023-05-24","2023-05-24","2025-03-20","2025-03-19","2025-06-11","2025-06-11","2024-06-04","2024-06-04","2023-10-02","2024-03-06","2024-04-22","2024-09-10","2023-05-24","2025-05-13","2024-08-14","2024-05-28","2025-02-28","2024-03-28","2025-02-02","2024-09-10","2024-09-10","2025-02-27","2025-06-10","2024-07-12","2025-06-17","2023-10-02","2024-07-25","2024-03-28","2024-04-15","2024-04-15","2024-10-15","2023-06-26","2024-05-02","2024-05-17","2023-09-18","2024-03-06","2024-04-15","2024-05-17","2024-05-28","2022-11-01","2022-09-26"],"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":[["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","MORPHINE SULFATE ER","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","MORPHINE SULFATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","VERAPAMIL SR","","","Select","Select",""],["","","TERBINAFINE HCL","","","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":""}]}]}