{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diana L Dove","gend":1,"currentgend":"","add":"30 GOVERNORS WAY UNIT 583","city":"TOPSHAM","state":"ME","zip":"04086","dob":"1946-01-08","age":"","mstatus":"","insh":"10000074916","cliId":"","pno":2078416310,"cno":"","email":"dldove4@hotmail.com","ename":"","eno":"","pphy":"ANDERSON, JULIANNA","ppno":2077984400,"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":"30 GOVERNORS WAY UNIT 583","madd2":"","madd3":"","mcity":"TOPSHAM","mstate":"ME","mzip":"04086","pcpfaxno":2077984018,"pcpnpi":1841907607,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1HC0MT7KP21","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":["F900","F423","F09","R0789","R1084","F419","F3342","N858","M810","N83201","D270","N838","R1900","F418","R4182","N898","N83291","R1012","K219","G3184","R109","E785","H25813","H21233","H527","F03A4","D271","K5900","R1909","F988","S60222A","I499","N83209","R140","I700","K7689","N281","M5412","M25512","M62838","R635","Z6827","Z23","M5010","M4722","M1812","M7989","M85842","F902","I4719","K449","R932","K769","F325","N393","Z0001","Z7189","Z1231","Z1211","Z86010","K635","K5730"],"date":["2025-04-18","2025-04-18","2025-04-18","2025-11-13","2025-08-12","2024-03-08","2025-10-06","2023-03-23","2025-11-13","2025-02-24","2025-02-24","2025-02-24","2025-03-12","2025-02-24","2025-02-24","2024-12-04","2024-10-16","2023-02-17","2024-09-23","2024-09-23","2025-08-12","2024-09-23","2023-10-27","2023-10-27","2023-10-27","2023-10-23","2025-02-24","2023-02-17","2023-04-17","2024-03-08","2023-01-28","2025-09-11","2023-03-23","2023-09-15","2025-08-12","2025-08-12","2025-08-12","2025-07-25","2025-07-25","2025-08-01","2023-09-15","2023-09-15","2024-10-01","2025-06-26","2025-06-26","2023-01-28","2023-01-28","2023-01-28","2023-01-26","2025-09-12","2023-02-17","2023-02-17","2023-02-17","2023-01-26","2022-10-25","2022-08-22","2022-08-22","2022-08-22","2022-08-18","2022-08-18","2022-08-18","2022-08-18"],"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":[["","","AMOXICILLIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ACETIC ACID","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","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":""}]}]}