{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karen Montejano","gend":1,"currentgend":"","add":"335 SOUTH ST","city":"Biddeford","state":"ME","zip":"04005","dob":"1959-06-22","age":"","mstatus":"","insh":"10000069211","cliId":"","pno":2072847220,"cno":"","email":"","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":"335 SOUTH ST","madd2":"","madd3":"","mcity":"Biddeford","mstate":"ME","mzip":"04005","pcpfaxno":2073968632,"pcpnpi":1538106679,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1QW8NR0NG21","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","M654","M19032","E785","I5032","M25532","Z87891","Z122","Z0000","K2950","K317","I319","I480","R0600","K7460","E1142","R0602","R000","M109","Z79899","I10","K7581","K760","E889","R140","K219","N1831","M7910","M041","N179","R0609","I130","K7469","Z0100","H5203","H52223","H524","I340","Z1231","I5043","J984","N6092","K7689","R059","C220","R197","E119","R936","M19071","I2510","I493","I4720","R008","E790","M061","M79674","R945","M79671","M7989","D509","R112","Z98890","K766","K3189","Z13810","L732","R2231","R1900","Z9089","U071"],"date":["2025-10-08","2023-03-30","2023-03-30","2025-11-11","2025-10-27","2023-04-13","2024-11-22","2024-11-22","2025-07-15","2024-05-01","2024-05-01","2025-04-04","2025-01-04","2023-10-20","2024-11-20","2024-09-06","2025-04-04","2023-10-27","2025-03-20","2025-03-20","2024-04-01","2025-09-11","2025-03-13","2025-03-13","2025-09-11","2025-03-13","2023-10-26","2023-02-06","2023-02-06","2023-10-22","2023-10-21","2023-10-20","2024-04-29","2025-03-06","2023-11-28","2023-11-28","2023-11-28","2025-08-05","2024-11-22","2024-07-02","2023-10-25","2024-11-22","2025-03-26","2023-10-13","2023-07-13","2024-02-14","2025-09-11","2023-04-05","2023-04-05","2024-01-12","2025-08-26","2025-08-26","2025-08-26","2023-02-06","2023-02-06","2022-09-22","2022-09-20","2022-09-15","2022-09-15","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-07-01","2022-05-24","2022-05-24","2022-05-10","2022-06-02"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","VASCEPA","","","Select","Select",""],["","","FLUZONE QUAD 2023-2024","","","Select","Select",""],["","","OMEGA-3 ACID ETHYL ESTERS","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PROBENECID-COLCHICINE","","","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":""}]}]}