{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dennis J Gratto","gend":0,"currentgend":"","add":"134 SAUGUS ST","city":"PORTLAND","state":"ME","zip":"04103","dob":"1951-06-10","age":"","mstatus":"","insh":"10000062185","cliId":"","pno":2078785751,"cno":"","email":"declined@09202019.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":"134 SAUGUS ST","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2078282433,"pcpnpi":1477992097,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5PM9WJ9FV14","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":["Z96651","Z471","M25661","M6281","M25561","M25461","M25531","M19031","Z13220","Z13228","G5601","R9720","M109","E6601","Z6839","H52223","H5212","H401111","H40012","H2513","L570","L814","Z85828","L578","R059","R0981","H43391","Z131","R5383","G8918","M170","M1711","H40013","M19039","D62","L03115","M7989","M19041","M1811","S63501A","M1712","Z96652","M25562","M25462","C4441","L821","R262","Z23","H6123","Z0189","Z8042","Z125","Z01812","E669"],"date":["2024-11-04","2023-11-16","2024-04-25","2024-04-25","2024-04-25","2024-04-25","2024-11-06","2024-11-06","2025-02-04","2025-02-04","2024-12-10","2025-01-27","2024-01-31","2024-12-10","2024-12-10","2025-06-20","2025-06-20","2025-10-15","2025-10-15","2025-10-15","2025-10-16","2025-10-16","2025-10-16","2025-10-16","2024-06-14","2024-06-05","2025-10-15","2025-02-04","2025-02-04","2023-11-02","2023-11-02","2023-11-03","2024-07-23","2024-11-04","2023-11-02","2024-02-04","2024-08-25","2024-08-25","2024-08-25","2024-08-25","2023-03-13","2023-04-13","2023-03-29","2023-03-29","2025-10-16","2025-10-16","2022-12-29","2023-10-18","2022-12-09","2022-12-02","2022-12-02","2022-12-02","2023-10-19","2022-12-19"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","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":""}]}]}