{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbara A Ward","gend":1,"currentgend":"","add":"195 HUFFS MILL RD","city":"Bowdoin","state":"ME","zip":"04287","dob":"1953-01-30","age":"","mstatus":"","insh":"10000060529","cliId":"","pno":2078377704,"cno":"","email":"webjetta@hotmail.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":"195 HUFFS MILL RD","madd2":"","madd3":"","mcity":"Bowdoin","mstate":"ME","mzip":"04287","pcpfaxno":2078287850,"pcpnpi":1023030020,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5G40JR3RP44","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":["I889","Z13220","Z79899","S46011A","M25511","L821","T148XXA","D84821","K121","T380X5A","S52502A","Z1231","J029","G500","R519","D803","E8352","R6889","J392","Z87891","M352","Z7952","J3481","K1370","S52592D","M26649","B370","K134","K1239","M609","K135","S52502D","J358","S52532D","S52572D","R5381","Z743","R531","J028","J45909","R4182","Z8619","H5710","H9209","Z130","K529","G9341","R5383","R070","J22","S52532A","M25532","J9811","R7989","R509","R0602","A419","D729","Z87440","Z0101","R748","I517","K760","R7401","R410","I629","R197","N390","M8588","J310","R9431","J449","D3132","I2129"],"date":["2023-08-10","2025-06-17","2025-06-17","2024-07-29","2024-07-29","2024-06-17","2023-09-28","2023-09-28","2025-08-06","2023-09-28","2025-10-01","2025-08-19","2025-03-29","2023-09-28","2023-09-28","2024-11-13","2023-10-04","2022-12-28","2023-09-21","2024-03-19","2025-05-07","2025-08-06","2023-09-21","2023-09-21","2025-10-01","2023-08-10","2023-08-10","2023-09-21","2023-09-21","2023-09-21","2023-09-21","2025-09-10","2025-04-10","2025-10-15","2025-10-01","2025-03-29","2025-03-29","2025-04-10","2023-05-21","2023-09-21","2023-09-21","2025-08-06","2023-08-18","2023-08-18","2024-06-17","2025-04-10","2025-04-10","2025-04-18","2023-06-07","2024-02-22","2025-08-29","2025-08-29","2025-03-29","2025-03-29","2025-03-29","2025-03-29","2025-04-08","2025-04-04","2025-04-18","2025-05-22","2025-05-19","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-03-30","2024-09-25","2025-03-29","2025-03-30","2025-03-30","2024-01-15","2025-03-30"],"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":[["","","ALPRAZOLAM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","AZATHIOPRINE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OTEZLA","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CLOTRIMAZOLE","","","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":""}]}]}