{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Valerie R Jacob","gend":1,"currentgend":"","add":"19 RYEFIELD DR","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1961-12-04","age":"","mstatus":"","insh":"10000067278","cliId":"","pno":2078836793,"cno":"","email":"","ename":"","eno":"","pphy":"SONTI, SMITA","ppno":2077998596,"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":"19 RYEFIELD DR","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":2078287850,"pcpnpi":1992904080,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6MR1E31KD14","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A6920","I890","R5382","E559","E639","Z8349","M9903","M9904","M9905","M9908","R109","M25552","N200","M7989","I872","M9900","R3129","G90522","M9909","R1031","A449","B6009","R7989","Z13228","Z1231","Z1389","Z1279","L929","B351","M9902","R5383","E7210","L820","Z1211","Z0101","H2513","M9906","Z85831","M9901","K760","K7689","R140","R197","Z13220","G8929","M9907","G4701","I878","Z136","Z85828","L578","D225","C44509","N3281","L209","D485","L089","R600","R21","R350","N390","M79671"],"date":["2024-07-24","2024-10-21","2024-04-29","2024-04-29","2024-04-29","2022-11-23","2024-02-08","2024-02-08","2023-11-14","2024-02-08","2023-01-03","2024-10-11","2025-01-21","2023-11-21","2023-12-08","2024-02-08","2022-11-02","2024-06-06","2023-09-19","2025-08-28","2024-07-24","2024-07-24","2024-04-29","2024-03-15","2025-06-30","2024-06-12","2024-06-12","2023-08-23","2023-08-23","2023-11-14","2023-05-02","2023-10-06","2025-07-23","2024-03-28","2025-07-23","2025-07-23","2023-03-07","2023-03-02","2023-05-31","2025-01-21","2025-01-21","2025-08-28","2025-08-28","2025-03-20","2025-08-22","2023-03-07","2023-01-03","2022-12-01","2025-03-20","2023-07-10","2023-07-10","2023-07-10","2023-07-10","2023-07-12","2023-02-09","2023-01-18","2023-01-24","2025-05-01","2023-01-18","2022-09-26","2022-09-26","2022-09-26"],"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":[["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUCELVAX QUAD 2023-2024","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","ATOVAQUONE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","RIFAMPIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ADACEL TDAP","","","Select","Select",""],["","","FLUCELVAX QUAD 2022-2023","","","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":""}]}]}