{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jill A Henderson","gend":1,"currentgend":"","add":"120 MIGHTY ST","city":"GORHAM","state":"ME","zip":"04038","dob":"1955-05-26","age":"","mstatus":"","insh":"10000077542","cliId":"","pno":2078396049,"cno":"","email":"jhill6049@maine.rr.com","ename":"","eno":"","pphy":"CLARK, SHERI","ppno":2078392559,"pcpadd":"Martins Point Health Care,153 US Rte 1","pcpcity":"Scarborough","pcpstate":"ME","pcpzip":"04074","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"120 MIGHTY ST","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":2075231135,"pcpnpi":1821095241,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4P41P13RN33","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":["R197","M1611","E669","K219","E785","D124","Z1231","Z471","S52509A","S6992XA","C641","M1711","H25812","H02831","H02834","D3502","N281","K7689","C649","D23111","L570","L821","L400","L818","L905","S52522A","H539","S52532A","Z85828","Z86018","L723","D4101","E278","Z0101","E119","H02833","H02836","R152","K2270","Z85528","H25811","K625","S0011XA","H43822","H25813","R42","Z96641","R410","S0511XA","D3501","D175","E1136","S0990XA","K635","K222","K5730","K449","I9742","K9172","Z23","C541","R932","K760","M160","Z87891","I2510","R918","M25551","M25552","L820","S52532D","J449","Z01812","R350","S199XXA","S0003XA","W19XXXA","R296","Z96649","D123","D122","J069","J9801","N2889","R053","S32019A","E279","R6889","R21","D239","C44311","R008"],"date":["2025-08-15","2025-04-23","2025-01-22","2025-01-22","2025-01-22","2024-03-12","2023-12-01","2025-01-23","2025-03-04","2025-03-04","2025-07-17","2025-01-22","2025-04-10","2025-05-16","2025-05-16","2025-07-07","2024-07-03","2024-07-03","2024-07-03","2025-05-16","2023-08-02","2023-08-02","2023-08-02","2023-08-02","2023-08-02","2025-03-04","2025-06-04","2025-03-24","2023-01-25","2023-01-25","2023-01-25","2023-05-18","2023-06-06","2024-05-17","2024-05-17","2024-05-17","2024-05-17","2024-05-28","2024-05-28","2025-07-07","2025-03-27","2023-05-09","2025-02-05","2025-01-06","2025-01-06","2025-04-23","2025-04-23","2025-02-05","2025-02-05","2023-05-18","2023-05-18","2025-04-16","2025-08-03","2024-03-12","2024-03-12","2024-03-12","2024-03-12","2023-05-18","2023-05-18","2025-10-13","2023-05-18","2025-08-15","2025-08-15","2024-10-30","2023-12-21","2023-12-21","2025-07-07","2024-10-30","2024-10-30","2025-05-16","2025-04-14","2023-05-18","2025-01-14","2024-07-11","2025-08-03","2025-08-03","2025-03-04","2025-03-04","2025-03-04","2024-03-12","2024-03-12","2022-11-11","2022-11-11","2022-11-15","2022-11-11","2022-08-08","2022-08-08","2022-08-19","2022-06-23","2022-06-13","2022-06-13","2022-04-25"],"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":[["","","GLIPIZIDE ER","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","CEFDINIR","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}