{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Julia C Hickory","gend":1,"currentgend":"","add":"115 SHERWOOD ST APT 3","city":"PORTLAND","state":"ME","zip":"04103","dob":"1953-08-01","age":"","mstatus":"","insh":"10000061319","cliId":"","pno":2073184632,"cno":"","email":"Jules7601@gmail.com","ename":"","eno":"","pphy":"CROTHERS, DANIEL S","ppno":2078282402,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"115 SHERWOOD ST APT 3","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2078282433,"pcpnpi":1336601996,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6P23DQ5VT85","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":["M9903","M9902","M9904","M9905","M5432","M4325","H401131","M5416","G43B0","H539","H47011","M9906","M47816","H43813","Q141","M7918","Z86010","Z85038","I87322","S46011D","M25611","R202","C4402","R200","I87323","L568","R6889","L570","D040","M9908","M9907","Z1231","M7700","G629","M25511","M542","M9901","M810","I6782","H5461","F419","I87321","D492","E785","H5319","M9900","Z1389","Z23","M4185","R208","G8929","M5136","M4186"],"date":["2023-01-26","2023-08-07","2023-01-26","2023-05-22","2024-10-09","2024-10-09","2025-10-15","2025-02-11","2024-12-16","2023-05-01","2025-10-15","2023-05-22","2022-12-02","2025-10-15","2023-12-04","2023-11-06","2024-07-03","2024-07-03","2024-01-24","2023-07-11","2023-07-11","2023-08-07","2024-09-27","2023-08-07","2023-12-05","2024-05-17","2023-01-24","2024-09-27","2024-08-06","2023-05-22","2023-03-27","2024-01-19","2023-05-22","2023-03-27","2023-08-07","2023-08-07","2023-08-07","2025-11-18","2024-06-18","2024-06-18","2024-12-23","2023-11-14","2024-08-06","2025-11-18","2025-10-15","2023-05-22","2024-06-18","2022-10-27","2022-08-17","2022-08-09","2022-08-09","2022-08-17","2022-08-17"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUZONE TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","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":[]}},{"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":""}]}]}