{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stacey J Cantara","gend":1,"currentgend":"","add":"114 GLECKLER RD","city":"PORTLAND","state":"ME","zip":"04103","dob":"1971-08-12","age":"","mstatus":"","insh":"10000058647","cliId":"","pno":2074237878,"cno":2074237878,"email":"declined@12092024.com","ename":"","eno":"","pphy":"KINGMAN, MEAGAN R","ppno":2078282402,"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":"114 GLECKLER RD","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2078282433,"pcpnpi":1477992097,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AH9W13CN25","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":["E66813","E119","Z9884","M797","Z01818","F319","E6601","G43001","K862","I951","K8689","Z87898","R2241","Z0101","Z83518","R6889","M546","G5751","S61213A","M533","G4700","Z23","R197","N6452","F3132","F4310","F419","Z79899","M0609","G43909","F3175","Z87891","M7989","R7401","M79604","F17200","M5442","Z0189","M79672","F17210","J069","E7800","D136","D369","Z803","Z808","E669","F418","K2970","M67471","M069","M25571","M19071","M79671","S9032XA","R918","R002","D017","K2950","I491","I493","Z6841","E282","N6451","D490","F3181","Z1321","R911","G43709","G44201","K2960","K317","H16223","M79661","Z6832","Z1231","Q6652","Q6651","M25572","Z01419","Z124","F32A","B351","K1230","K121","R519","J029","Z20822","K120","H60501"],"date":["2025-11-13","2025-11-13","2025-10-22","2023-04-28","2025-09-12","2025-10-23","2025-09-12","2025-08-11","2025-09-15","2025-03-05","2025-09-15","2025-09-17","2023-01-19","2025-04-01","2025-04-01","2023-02-27","2023-04-12","2023-01-19","2023-04-28","2024-02-09","2025-10-23","2025-10-10","2024-03-18","2025-05-19","2025-03-18","2025-10-23","2025-10-23","2025-11-10","2025-11-10","2025-10-10","2024-08-22","2025-10-27","2023-01-19","2023-09-01","2023-01-19","2023-06-14","2023-08-15","2024-03-18","2025-07-16","2023-08-15","2023-10-15","2025-04-30","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-06","2025-09-12","2025-09-12","2023-01-19","2022-12-19","2022-12-19","2022-12-01","2022-12-01","2025-07-16","2023-07-12","2025-03-05","2025-09-15","2025-09-12","2025-04-07","2025-04-07","2025-11-13","2025-11-13","2025-04-30","2025-09-18","2024-01-24","2025-09-26","2023-10-13","2023-04-28","2023-04-28","2025-09-12","2025-09-12","2022-10-31","2022-11-07","2022-10-24","2022-09-28","2022-09-19","2022-09-19","2022-09-19","2022-09-01","2022-09-01","2022-08-05","2022-06-24","2022-05-23","2022-05-26","2022-05-20","2022-05-10","2022-05-10","2022-05-08","2022-05-08"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUDROCORTISONE ACETATE","","","Select","Select",""],["","","AIMOVIG AUTOINJECTOR","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","HUMIRA(CF) PEN","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","ADALIMUMAB-ADAZ(CF) PEN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","UBRELVY","","","Select","Select",""],["","","VICTOZA 3-PAK","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","VICTOZA 2-PAK","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","LEUCOVORIN CALCIUM","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}