{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marian P Carney","gend":1,"currentgend":"","add":"10 CLIFFSIDE RD","city":"CASCO","state":"ME","zip":"04015","dob":"1954-05-26","age":"","mstatus":"","insh":"10000078126","cliId":"","pno":2075771369,"cno":"","email":"mariancarney66@gmail.com","ename":"","eno":"","pphy":"KENNEY, BRUCE W","ppno":2077952800,"pcpadd":"76 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"POLAND COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 CLIFFSIDE RD","madd2":"","madd3":"","mcity":"CASCO","mstate":"ME","mzip":"04015","pcpfaxno":2077952808,"pcpnpi":1629058185,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9RD7FM2VJ48","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M353","M0600","Z79899","M1990","M19041","I10","Z1231","M19032","Z0389","M1812","M19031","M25531","M170","Z5181","C3411","C3490","R1011","N950","K760","K8020","J449","M6281","R2681","M25661","M25561","L989","E559","M810","M65311","L821","L814","D225","L720","M19071","R911","D259","L03113","Z0000","M1712","M25562","M79662","M25662","H259","J984","Z01812","Z96652","Z85118","J439","R918","H40013","K862","L820","L280","L858","L089","M25462","R6889","M150","M1711","L308","L309","Z7952","Z96651","Z471","Z780","L603","G8918","L739","H25813","H04123","L0390","K219","B351","Z539","L2089","Z1211","Z0189","K589","H2513","H25812","H25811","S30861S","W57XXXS","Z23","M79675","M79674","L600","Z5111","Z98890","R590","J939","R059","R079","F17211","Z8042"],"date":["2025-10-14","2025-10-14","2023-02-16","2024-07-09","2023-03-20","2025-06-02","2025-10-09","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2024-05-21","2025-03-11","2025-06-05","2025-06-04","2025-03-12","2023-09-06","2025-03-24","2025-03-24","2024-08-06","2024-11-05","2024-11-05","2024-11-05","2024-11-05","2024-07-15","2023-09-12","2025-10-14","2023-07-26","2024-07-10","2024-07-10","2024-07-10","2024-12-09","2023-03-20","2024-08-06","2023-07-07","2025-07-18","2025-04-04","2024-08-27","2024-08-05","2024-08-05","2024-08-05","2024-03-21","2024-07-09","2024-08-14","2024-07-18","2024-10-16","2025-01-10","2025-01-10","2025-04-17","2025-07-31","2024-05-09","2024-05-09","2024-05-09","2024-05-09","2024-08-05","2023-12-13","2025-08-11","2024-08-27","2024-05-09","2024-05-09","2025-06-05","2025-07-28","2024-10-16","2023-06-12","2025-10-09","2024-08-27","2024-05-03","2023-12-18","2023-12-18","2025-05-25","2024-08-27","2025-10-09","2023-08-17","2024-12-09","2025-04-16","2025-07-28","2025-01-14","2023-06-12","2024-03-07","2024-03-21","2025-07-18","2025-07-18","2023-12-29","2025-10-09","2025-10-09","2025-10-09","2022-11-01","2022-09-16","2022-09-16","2022-09-16","2022-09-27","2022-09-27","2022-08-08","2022-08-08"],"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":[["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","SULFASALAZINE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","LEFLUNOMIDE","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","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":""}]}]}