{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane M Simonds","gend":1,"currentgend":"","add":"16 SMITHWHEEL UNIT 13","city":"OLD ORCHARD BEACH","state":"ME","zip":"04064","dob":"1959-11-29","age":"","mstatus":"","insh":"10000075913","cliId":"","pno":2076020112,"cno":"","email":"Disimonds001@gmail.com","ename":"","eno":"","pphy":"HINE, JENNIFER L","ppno":2077984400,"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":"16 SMITHWHEEL UNIT 13","madd2":"","madd3":"","mcity":"OLD ORCHARD BEACH","mstate":"ME","mzip":"04064","pcpfaxno":2077984018,"pcpnpi":1922031657,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7KM3WD9FP19","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":["R053","F411","D123","Z1211","K5730","K648","R918","F17200","R059","Z713","F429","D509","I081","F22","F422","J984","Z1231","F29","R911","H40013","H5203","H52222","H524","H43813","I639","I6389","R5382","R1011","R079","Z136","R8290","R6889","K219","E6601","Z0000","H538","R0683","K8020","K760","K7689","H9312","R222","H6992","H539","Z87891","F419","Z0184","E559","R0609","G20C","Z77098","K439","F4325","M25512","G4733","K3189","E669","E785","R12","R45851","K920","R4589","R451","R45850","R1909","L821","L814","D1801","F325"],"date":["2025-08-29","2025-11-13","2023-10-16","2023-10-16","2023-10-16","2023-10-16","2024-11-26","2024-08-29","2025-05-16","2023-06-14","2025-10-30","2025-11-07","2024-02-09","2025-10-02","2024-09-16","2025-05-16","2024-06-11","2024-03-30","2025-08-29","2025-03-12","2025-03-12","2025-03-12","2025-03-12","2025-03-12","2024-03-01","2024-02-08","2025-08-26","2025-11-04","2025-05-16","2024-11-29","2025-07-14","2023-06-26","2024-01-23","2024-01-23","2024-01-23","2024-11-28","2025-10-14","2025-11-04","2025-11-04","2025-11-04","2024-11-28","2025-07-24","2024-11-28","2024-11-28","2025-05-15","2024-02-17","2023-09-14","2023-03-30","2023-10-26","2024-02-20","2025-05-15","2024-04-30","2024-04-16","2025-05-15","2025-10-14","2023-04-18","2023-03-30","2025-04-09","2023-10-11","2024-01-20","2025-04-09","2024-01-20","2024-01-20","2024-01-20","2025-07-24","2023-10-24","2023-10-24","2023-10-24","2022-10-17"],"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":[["","","ARIPIPRAZOLE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLOVENT HFA","","","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":""}]}]}