{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Teresa C Giroux","gend":1,"currentgend":"","add":"257 CANCO RD APT 208","city":"PORTLAND","state":"ME","zip":"04103","dob":"1928-10-07","age":"","mstatus":"","insh":"10000069887","cliId":"","pno":2076519042,"cno":2076515785,"email":"BARRJR1975@GMAIL.COM","ename":"","eno":"","pphy":"BARR, DOUGLAS","ppno":2077745816,"pcpadd":"100 FODEN RD WEST,STE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1999 CRESTWIND BLVD SUZAN GOVE","madd2":"","madd3":"","mcity":"MYRTLE BEACH","mstate":"SC","mzip":"29577","pcpfaxno":2078741483,"pcpnpi":1134180359,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4MF7UD0HG20","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K5732","J449","R0902","Z9981","Z66","R0981","M6281","R2689","S32010D","Z0001","B351","M79674","M79675","I441","M79671","E039","K5289","Z950","H353124","H43812","M50122","M4722","H35341","Z45010","H353212","R55","Z45018","B354","B350","H353231","R0602","R059","L820","L299","Z85828","L578","R233","L821","M5412","I083","R197","K5730","R109","E7800","S32019A","S32010A","S92009A","Z23","R053","Z03818","K5733","B342","H353190","K529","F329","S92912A","S92025A","S20219A","Z87891","L720","S299XXA","S99922A","S9032XA","J439","S0990XA","Z0000","M79672","M2042","M7070","N3281","M722","I4430","R1084","R194","R933","I10","M205X1","M21621","R208","H353221","R0609","M7601","A000","M6530","H353211","H353122","D225","D1801","R0683","I351","I700","I288","M48061"],"date":["2023-03-24","2025-11-18","2025-11-18","2023-03-24","2025-06-23","2024-02-05","2025-04-11","2025-04-11","2025-04-11","2025-06-23","2025-09-04","2025-09-04","2025-09-04","2025-06-10","2024-10-04","2025-08-20","2023-03-24","2025-11-17","2023-02-27","2023-02-27","2024-03-20","2024-03-20","2023-02-27","2023-10-03","2023-02-27","2024-03-20","2023-11-03","2025-07-03","2025-07-03","2023-11-01","2024-02-05","2025-06-20","2023-07-19","2023-07-19","2024-07-17","2023-07-19","2023-07-19","2024-07-17","2024-08-03","2023-08-24","2025-06-23","2023-03-24","2023-03-24","2025-07-09","2025-02-11","2025-02-14","2025-02-14","2025-02-14","2025-06-20","2025-06-20","2023-03-25","2022-12-23","2023-08-25","2023-11-17","2023-11-17","2025-02-12","2025-02-11","2025-02-11","2025-02-11","2024-07-17","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2022-12-30","2024-10-04","2024-10-04","2023-08-25","2023-05-31","2025-09-04","2023-10-03","2023-03-27","2023-03-27","2023-03-27","2023-02-21","2022-10-28","2022-10-28","2022-10-21","2022-10-05","2022-09-13","2022-06-28","2022-06-28","2022-06-21","2022-06-01","2022-06-01","2021-10-08","2021-10-08","2021-11-03","2021-10-14","2021-10-22","2021-10-22","2021-10-03"],"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":[["","","FLUCONAZOLE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","TOLTERODINE TARTRATE ER","","","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":""}]}]}