{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roxanne E Barker","gend":1,"currentgend":"","add":"27 SHAWS MILL RD","city":"STANDISH","state":"ME","zip":"04084","dob":"1951-12-31","age":"","mstatus":"","insh":"10000069104","cliId":"","pno":2072293906,"cno":"","email":"","ename":"","eno":"","pphy":"FAY SHIELDS, JACOB A","ppno":2078392559,"pcpadd":"Martins Point Health Care,575 Main St","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"27 SHAWS MILL RD","madd2":"","madd3":"","mcity":"STANDISH","mstate":"ME","mzip":"04084","pcpfaxno":2075231135,"pcpnpi":1467038042,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2UP3D50HC91","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":["E119","N390","R5383","J849","J479","R161","I2510","R160","R748","D509","M25561","M25562","G8929","R2689","M9902","G44219","M9901","M9903","J8410","R1314","I8500","K219","E039","D649","H25811","K7469","M069","Z1231","J438","R918","M068A","H259","L570","R350","L821","K922","R1310","J449","Z23","J984","Z1211","D125","M0579","Z79899","K5730","R4182","J851","J8489","R945","J189","F32A","L920","I10","K7460","I3481","Z0101","K766","R300","R3915","H25812","H43822","H35352","H2513","Z87891","K222","R0902","N281","R7989","R112","K920","R58","B379","Z862","R932","R188","R109","H25813","R6889","D485","R309","K449","R079","J9601","B372","J9691","R509","R0781","Z7984","A419","J181","I319","R0689","I700","I701"],"date":["2025-11-12","2023-12-27","2024-03-28","2025-03-04","2025-03-04","2024-01-05","2025-03-04","2024-11-15","2023-09-28","2024-06-27","2025-03-26","2025-03-26","2025-03-26","2025-03-26","2025-11-10","2025-11-10","2025-11-10","2025-11-10","2025-03-24","2025-10-21","2025-10-21","2025-10-21","2025-10-21","2025-10-09","2023-06-19","2025-04-18","2025-04-09","2025-05-12","2025-01-22","2025-01-22","2025-04-09","2023-06-19","2025-03-11","2025-11-05","2023-06-14","2025-04-21","2025-04-21","2025-04-21","2025-08-06","2025-04-09","2024-07-01","2024-07-01","2025-10-09","2025-10-09","2024-07-01","2025-04-18","2023-01-05","2023-01-05","2024-01-17","2022-12-14","2025-04-18","2025-06-26","2024-05-22","2024-12-05","2025-03-04","2025-02-05","2024-12-05","2025-11-05","2025-11-05","2023-06-19","2024-01-24","2023-01-24","2023-05-08","2025-04-18","2025-04-18","2024-01-11","2024-11-12","2023-09-28","2025-04-21","2025-04-21","2025-04-21","2024-06-10","2024-08-30","2024-11-12","2024-06-12","2024-06-12","2023-05-17","2023-02-01","2023-06-14","2022-11-07","2022-10-20","2022-09-11","2022-09-12","2022-09-12","2022-09-07","2022-09-05","2022-09-05","2022-09-05","2022-09-04","2022-09-05","2022-09-06","2022-09-04","2022-09-04","2022-09-04"],"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",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","JANUMET","","","Select","Select",""],["","","BEVESPI AEROSPHERE","","","Select","Select",""],["","","NADOLOL","","","Select","Select",""],["","","ORENCIA CLICKJECT","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","CIMZIA (2 PACK)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","CIMZIA","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ATROVENT HFA","","","Select","Select",""],["","","AZITHROMYCIN","","","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":[]}},{"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":""}]}]}