{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joanna Gile","gend":1,"currentgend":"","add":"232 FEDERAL ST","city":"Alfred","state":"ME","zip":"04002","dob":"1972-06-15","age":"","mstatus":"","insh":"10000075468","cliId":"","pno":2074321380,"cno":"","email":"joannagile@gmail.com","ename":"","eno":"","pphy":"LETELLIER, TERESA","ppno":2072831441,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"232 FEDERAL ST","madd2":"","madd3":"","mcity":"Alfred","mstate":"ME","mzip":"04002","pcpfaxno":2075231136,"pcpnpi":1629431622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1KM6C20YK65","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":["F3160","F1021","F4312","D72829","D509","N12","E8342","K224","R1312","K3184","E119","F319","F411","Z79899","F5104","Z713","N390","R112","R350","I10","D6859","I7410","Z7901","R911","F1020","G4733","R5383","M2550","R110","R109","R197","K52831","K219","E669","I83813","M1711","R2689","R1310","K529","N3000","L918","R918","M1811","M1812","G4739","R0902","R0683","Z1231","R300","R1314","Z23","I83891","K029","F418","G4730","Z0189","L989","F1291","M25551","Z0100","H8111","H8112","Z87891","M19011","M19012","R55","F3130","N2889","N3281","M25511","M25512","N281","R051","R7401","Z131","I5043","S46011D","S46012D","R569","R7303","M5450","R3915","M7910","M7918","D6861","R2241","M25561","M51370","M47816","M4317","F1220","M797","R413","G4700","D6862","Z86718","R1013","D485","K52839","M79641","M79642","F329","M25531","M25532","K52838","R6889","J45909","K2100","Q893","R3129","N898","E559","R059","U071","S76819A","N289","M180","I4581","G43909","F39","I5042","G43709","I5022","Z01810","T7589XA","R6330","R319","I43","E782","I5181","R778","G4089","I83811","D729","F1211","D735","I82891","F10129","G928","Z20822","I110","F1290"],"date":["2024-02-20","2024-01-25","2025-10-13","2024-09-30","2025-05-02","2023-07-12","2025-08-28","2024-06-06","2024-06-06","2024-06-06","2025-08-28","2025-09-11","2025-09-11","2025-09-11","2025-09-11","2023-05-22","2024-09-23","2024-08-21","2025-01-29","2025-09-22","2025-10-14","2025-10-14","2025-10-14","2024-04-16","2025-10-13","2025-10-28","2024-11-05","2023-09-22","2024-11-05","2024-11-05","2024-11-05","2024-10-10","2024-10-11","2024-06-06","2025-10-24","2024-08-08","2024-08-08","2025-10-01","2024-11-05","2024-01-10","2023-12-12","2023-01-19","2025-05-14","2025-05-14","2025-06-11","2025-06-11","2025-06-11","2025-09-09","2024-11-22","2025-09-05","2025-09-09","2025-09-26","2024-10-11","2024-10-11","2024-10-11","2024-09-23","2025-09-09","2024-01-05","2025-05-22","2024-12-30","2024-08-08","2024-08-08","2025-05-09","2023-02-07","2023-02-07","2024-06-25","2023-09-19","2025-08-05","2025-08-05","2023-02-22","2023-02-22","2025-07-18","2024-09-09","2024-09-30","2023-11-03","2024-09-06","2023-02-22","2023-02-22","2024-07-31","2025-04-29","2025-01-16","2024-04-29","2024-04-30","2023-07-12","2023-07-12","2025-04-29","2024-11-25","2025-01-16","2025-01-16","2025-01-16","2023-06-29","2025-01-21","2025-01-21","2025-01-28","2023-10-26","2025-09-26","2023-01-17","2023-11-03","2023-01-17","2025-05-14","2025-05-14","2023-10-26","2025-05-14","2025-05-14","2024-02-05","2024-02-09","2024-06-06","2023-03-10","2023-03-10","2024-03-18","2023-12-12","2023-03-16","2024-09-09","2024-09-09","2025-08-11","2024-06-24","2025-05-14","2025-07-10","2024-03-07","2025-02-21","2024-03-27","2025-09-19","2025-09-22","2024-09-23","2025-11-10","2024-09-30","2024-03-18","2025-09-22","2025-09-22","2022-12-21","2022-12-21","2022-12-21","2025-10-03","2024-09-23","2022-10-31","2022-10-18","2022-06-16","2022-05-21","2022-04-24","2022-04-14","2022-04-08","2022-04-08"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","BUDESONIDE DR","","","Select","Select",""],["","","LITHIUM CARBONATE ER","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","NURTEC ODT","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","RIZATRIPTAN","","","Select","Select",""],["","","VRAYLAR","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","SAVELLA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","SODIUM FLUORIDE","","","Select","Select",""],["","","PREVIDENT","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","AIMOVIG AUTOINJECTOR","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","EMGALITY PEN","","","Select","Select",""],["","","BUDESONIDE EC","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","LURASIDONE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","LITHIUM CARBONATE","","","Select","Select",""],["","","LAMOTRIGINE ER","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","BACLOFEN","","","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":""}]}]}