{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean M Goff","gend":1,"currentgend":"","add":"173 GRAY RD","city":"NORTH YARMOUTH","state":"ME","zip":"04097","dob":"1935-10-07","age":"","mstatus":"","insh":"10000072588","cliId":"","pno":2078293920,"cno":"","email":"declined@07122021.com","ename":"","eno":"","pphy":"EYERER, GEORGE","ppno":"","pcpadd":"Martins Point Health Care,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"173 GRAY RD","madd2":"","madd3":"","mcity":"NORTH YARMOUTH","mstate":"ME","mzip":"04097","pcpfaxno":"","pcpnpi":1841827169,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8FR8Q09UQ34","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":["N390","N184","F331","E875","N3281","R600","F3341","M7541","N3941","R350","D414","E1165","I10","R5383","M1711","E039","R059","F411","M549","N179","M47816","M51369","F324","H35363","Z0101","F419","J188","J9811","F32A","R4182","E1122","R310","R109","R918","I2510","I3481","I700","J189","M79641","N1832","Z0389","M24011","M19011","M25511","E785","A419","E119","H43813","D631","N1830","R7989","R300","R5381","N189","J0100","M25571","S91301A","Z96643","N1330","N2882","N2889","N12","N134","K5790","S60221A","J069","Z23","M25561","R0602","R0781","I129","S2020XA","D729","Z471","Z4542","H6123"],"date":["2025-05-08","2025-11-03","2025-09-26","2024-08-16","2024-10-09","2025-09-29","2025-03-14","2024-06-28","2025-11-03","2024-06-04","2024-06-04","2025-06-04","2025-08-13","2025-05-25","2022-12-05","2025-08-13","2025-05-08","2025-09-26","2025-08-19","2025-07-31","2025-10-16","2025-08-14","2024-12-27","2025-09-09","2024-07-30","2025-06-13","2025-05-27","2025-05-08","2024-10-09","2024-10-09","2025-11-03","2025-03-31","2023-09-29","2025-05-27","2025-08-19","2025-05-27","2025-05-27","2025-05-19","2025-02-12","2025-08-13","2025-11-03","2023-01-12","2023-01-12","2023-01-12","2025-08-13","2025-08-19","2025-01-30","2025-01-30","2023-06-29","2023-06-29","2023-02-22","2024-02-17","2025-05-25","2025-07-29","2023-12-07","2024-11-19","2024-11-19","2025-04-08","2025-08-19","2025-04-08","2025-04-08","2025-08-19","2025-08-19","2025-08-19","2025-02-12","2024-07-29","2025-09-08","2022-12-05","2024-09-18","2025-03-18","2025-07-29","2025-03-18","2025-05-19","2024-12-06","2024-09-18","2024-07-29"],"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":[["","","GLIPIZIDE","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CALCITRIOL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","TROSPIUM CHLORIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FESOTERODINE FUMARATE ER","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","GEMFIBROZIL","","","Select","Select",""],["","","SILVER SULFADIAZINE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","FREESTYLE LITE METER","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","SSD","","","Select","Select",""],["","","DAPAGLIFLOZIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}