{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mariea J Brooks","gend":1,"currentgend":"","add":"266 CASCO RD","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1954-09-06","age":"","mstatus":"","insh":"10000072579","cliId":"","pno":2078413095,"cno":"","email":"declined@11112025.com","ename":"","eno":"","pphy":"MAHER, JEFFREY P","ppno":2073736848,"pcpadd":"Mid Coast Medical Group,22 Station Ave Ste 101","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"266 CASCO RD","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":2077219808,"pcpnpi":1699886051,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1NH0EE2YQ37","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N12","J301","G8918","E119","H3092","A6920","H35352","Z1231","K8020","J45909","K219","G5603","R109","Z0000","E11319","I700","E6601","K7460","Z9049","J330","J324","E785","M25511","M25611","R6889","R7989","C50911","Z923","Z98890","I10","I4710","C50211","M859","M1990","Z23","Z08","E538","K760","K5732","L298","M654","K7689","H3090","K56690","R197","R002","R350","Z0101","J310","N10","R112","K56699","J309","Z0389","R1114","R928","J322","J320","R232","E782","R600","L2989","M810","Z79811","H2513","J4540","R140","J9811","R0989","J3089","N200","K5730","K449","K429","R160","G5601","K769","M19011","R748","N651","R933","K6389","R935","R1031","R5383","K635","Z853","Z90710","Z86010","L589","Z510","M8580","S8254XS"],"date":["2023-02-26","2025-11-04","2023-12-26","2025-10-06","2025-08-07","2025-08-07","2025-08-07","2025-01-28","2023-12-26","2023-12-26","2024-10-22","2024-06-03","2023-11-27","2023-10-09","2023-10-09","2025-03-11","2023-10-09","2025-10-30","2025-10-30","2024-10-22","2024-10-30","2024-10-22","2025-05-15","2025-05-15","2022-12-14","2024-09-09","2023-02-06","2023-02-06","2023-02-06","2025-10-31","2025-07-17","2024-10-23","2024-10-23","2024-10-23","2024-10-10","2022-12-21","2024-05-06","2025-04-15","2023-12-26","2024-08-06","2025-04-10","2023-11-28","2025-03-11","2023-12-26","2025-10-14","2025-04-15","2023-10-09","2025-02-06","2023-01-12","2023-09-20","2023-02-25","2024-01-16","2023-02-09","2025-03-11","2024-05-03","2022-12-21","2024-10-22","2024-06-07","2023-06-27","2023-11-07","2024-05-30","2024-10-23","2024-10-17","2024-10-17","2023-12-19","2025-10-31","2023-12-29","2023-12-29","2023-12-29","2023-10-12","2023-02-25","2023-02-25","2023-02-25","2023-02-25","2024-05-15","2023-12-12","2023-11-28","2025-01-14","2023-05-23","2022-10-03","2022-09-29","2022-09-29","2022-09-29","2022-09-22","2022-09-21","2022-09-29","2022-09-21","2022-09-21","2022-09-29","2022-08-30","2022-04-11","2022-03-29","2022-04-07"],"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":[["","","BREO ELLIPTA","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BENAZEPRIL HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","LETROZOLE","","","Select","Select",""],["","","BUDESONIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","SSD","","","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":""}]}]}