{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary E Gordon","gend":1,"currentgend":"","add":"63 FOREST ST","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1957-06-16","age":"","mstatus":"","insh":"10000077149","cliId":"","pno":2078544488,"cno":"","email":"fgordonjr@maine.rr.com","ename":"","eno":"","pphy":"WATTS, JENNIFER L","ppno":2078392559,"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":"63 FOREST ST","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":2075231135,"pcpnpi":1679926828,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5GF7WQ2UF56","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":["J441","J438","M6281","M25551","G894","E785","J439","Z87891","Z122","G43719","S73191A","M7061","I10","H3551","F321","M1611","N1830","Z23","R600","I2510","Z7189","R251","Z01818","R0789","R931"],"date":["2025-06-02","2025-06-02","2025-04-08","2025-04-08","2024-11-13","2025-11-14","2024-05-14","2025-09-26","2025-09-26","2025-11-07","2024-08-30","2025-04-22","2025-11-14","2024-09-20","2023-09-14","2024-08-30","2025-11-14","2023-12-01","2023-08-02","2024-01-03","2023-01-05","2024-01-03","2024-12-16","2022-09-23","2022-09-23"],"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":[["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","VERAPAMIL HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OHTUVAYRE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","LEVALBUTEROL HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","QULIPTA","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","BEVESPI AEROSPHERE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}