{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vanessa M Tomlinson","gend":1,"currentgend":"","add":"160 GRANT ST","city":"PORTLAND","state":"ME","zip":"04101","dob":"1953-11-05","age":"","mstatus":"","insh":"10000062233","cliId":"","pno":2078070900,"cno":"","email":"declined@10292025.com","ename":"","eno":"","pphy":"DEGRINNEY, JOSEPH T","ppno":2078833491,"pcpadd":"301 US ROUTE 1,BUILDING C","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40747609","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"160 GRANT ST","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04101","pcpfaxno":2073968632,"pcpnpi":1538106679,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6Y85C71JP68","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":["E113313","Z961","E1142","Z794","E785","Z1231","R300","Z0000","Z23","D125","Z800","K5730","N889","R197","R0981","R748","L900","R87615","Z124","N904","N958","I10","Z1151","R1030","N952","B379","Z9181","H35372","E1165","K047","K5909","N898","B372","M48062","R6889","Z01812","Z20822","M48061","E119","E11319"],"date":["2025-11-12","2025-11-12","2025-10-14","2025-10-14","2025-07-10","2024-05-07","2023-12-15","2025-10-14","2025-10-14","2024-10-16","2024-10-16","2024-10-16","2023-07-31","2023-03-01","2023-03-01","2023-03-21","2025-07-28","2023-07-31","2023-05-09","2025-02-12","2025-07-28","2025-10-14","2023-04-18","2023-12-01","2025-02-12","2025-02-12","2023-09-19","2025-11-12","2024-12-09","2024-12-09","2024-12-09","2022-11-18","2022-11-18","2022-05-03","2022-08-05","2022-03-28","2022-03-28","2022-03-31","2022-03-31","2022-03-31"],"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":[["","","NOVOLIN 70-30","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","AMMONIUM LACTATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","HALOBETASOL PROPIONATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","ULTRA-FINE INSULIN SYRINGE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","OXYCODONE 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":{"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":""}]}]}