{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Helen A Lewis","gend":1,"currentgend":"","add":"56 LOUDEN RD","city":"SACO","state":"ME","zip":"04072","dob":"1949-11-29","age":"","mstatus":"","insh":"10000075990","cliId":"","pno":2072868515,"cno":"","email":"","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":"56 LOUDEN RD","madd2":"","madd3":"","mcity":"SACO","mstate":"ME","mzip":"04072","pcpfaxno":2075231136,"pcpnpi":1629431622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9X81V80PP90","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":["J440","G4733","H16202","H527","H35341","H04123","J449","C73","E041","I959","N3001","R350","R42","R2689","R739","R2681","M6281","Z1211","K51918","K5900","Z86010","Z8719","K5730","Z1231","N131","L820","J984","L570","R300","N135","E871","E039","F419","Z23","E890","R55","R4781","G459","I639","I10","I519","I340","E8342","I110","R296","L821","R519","R32","R531","M899","N1330","M1612","N390","L851","I7091","I739","B351","M79674","M79675","R29818","N3000","N3941","N3281","I517","I6523","E079","H903","E6601","I498","I4710","R0609","N3289","K8020","J90","R1110","K5180","K2100","Z79899","K5090"],"date":["2025-06-30","2025-06-30","2023-05-04","2025-11-04","2024-06-27","2024-06-27","2025-04-24","2025-10-29","2025-08-12","2023-09-13","2023-11-21","2023-09-13","2025-04-24","2025-05-21","2025-05-15","2025-05-21","2025-05-21","2024-07-03","2024-07-03","2024-07-03","2024-07-03","2024-07-03","2024-07-03","2025-04-01","2023-10-10","2024-02-07","2023-04-20","2025-05-14","2025-05-20","2024-09-05","2024-11-21","2024-11-07","2025-05-20","2025-05-20","2025-07-03","2025-05-06","2024-08-02","2024-08-02","2024-07-17","2025-05-15","2023-01-12","2024-07-10","2024-04-02","2023-09-13","2025-04-24","2024-02-07","2023-09-13","2023-09-13","2025-04-21","2023-11-14","2024-05-08","2023-11-14","2023-09-13","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2024-07-10","2024-08-28","2023-09-06","2023-09-06","2024-07-10","2024-07-09","2023-11-08","2025-01-28","2024-11-07","2025-05-06","2025-05-06","2023-07-19","2023-09-13","2023-09-13","2025-04-17","2025-04-17","2022-10-21","2022-10-17","2022-09-15","2022-09-08"],"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":[["","","CARVEDILOL","","","Select","Select",""],["","","MESALAMINE ER","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","INDAPAMIDE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","FESOTERODINE FUMARATE ER","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO 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":""}]}]}