{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bernadette Gorman","gend":1,"currentgend":"","add":"142 WOODLAWN AVE","city":"PORTLAND","state":"ME","zip":"04103","dob":"1960-05-26","age":"","mstatus":"","insh":"10000063469","cliId":"","pno":2078780666,"cno":2072452237,"email":"lydiacole1113@yahoo.com","ename":"","eno":"","pphy":"CONNOLLY, PATRICK J","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":"142 WOODLAWN AVE","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2078282425,"pcpnpi":1982655098,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6KH1Q18FT99","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":["J111","M25522","L918","Z23","M7541","M25511","M19022","M19012","M25512","W19XXXA","F17210","Z1152","Z8249","Z124","M67813","M19011","M19071","S43421D","S43101A","Z1231","Z136","K644","K648","E785","Z13228","H26491","M47816","J449","H43393","H02831","H02834","S4992XA","M75101","M79671","R52","R6889","R921","R928"],"date":["2023-12-06","2025-11-03","2024-02-06","2025-07-02","2023-07-25","2023-07-25","2025-11-03","2023-08-10","2023-08-10","2023-08-10","2023-12-06","2023-12-06","2024-07-17","2025-07-02","2023-07-24","2023-07-24","2025-07-02","2022-12-19","2023-07-11","2025-09-02","2024-07-17","2023-08-14","2023-08-14","2025-06-25","2025-06-25","2025-01-15","2024-06-26","2024-01-02","2024-12-17","2024-12-17","2024-12-17","2023-08-04","2023-06-12","2025-07-02","2024-06-26","2022-10-10","2022-08-12","2022-08-12"],"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":[["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","PREDNISONE","","","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":[]}},{"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":""}]}]}