{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Suzanne B Sherman","gend":1,"currentgend":"","add":"44 MCLELLAN ST","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1953-08-28","age":"","mstatus":"","insh":"10000066719","cliId":"","pno":2074156240,"cno":"","email":"sshermans@yahoo.com","ename":"","eno":"","pphy":"WHITE, SARAH B","ppno":2077984400,"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":"44 MCLELLAN ST","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":"","pcpnpi":1063702819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3G93Q00PG92","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":["F330","H25812","M2430","M542","R519","L821","H2511","R1011","L570","R7303","E785","M810","H6123","Z1211","M62838","M779","K5900","L719","H25813","H04123","H35372","F4312","F900","F321","Z13220","E162","H43813","Z961","R29898","H25811","T2691XA","H02402","Z1329","K6389","R1013","F418","E559","L710","H16223","R4182","S0006XA","W57XXXA","H02412","H2513","K589","D126","Z1231","K30","R1012","K5730","K635","D122","D123","Z86010"],"date":["2025-10-03","2023-03-20","2025-04-25","2024-08-22","2025-04-25","2025-01-23","2023-07-31","2023-02-17","2023-03-10","2025-10-02","2025-10-02","2025-10-02","2023-07-05","2025-08-27","2025-04-25","2025-04-25","2025-08-27","2024-03-19","2023-03-20","2024-10-07","2023-04-26","2025-11-10","2025-11-10","2025-11-10","2023-09-18","2023-09-18","2023-09-28","2023-04-04","2025-06-26","2023-03-20","2025-10-06","2024-10-07","2024-10-03","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2023-10-13","2024-09-18","2023-03-20","2025-05-08","2025-05-08","2023-04-26","2022-10-31","2022-10-06","2022-10-05","2022-09-06","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10"],"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":[["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","AZELAIC ACID","","","Select","Select",""],["","","LOTEPREDNOL ETABONATE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ALPRAZOLAM","","","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":""}]}]}