{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tracey L Kirkwood","gend":1,"currentgend":"","add":"38 Brewster St","city":"Bangor","state":"ME","zip":"04401","dob":"1962-06-23","age":"","mstatus":"","insh":"10000079180","cliId":"","pno":2078416646,"cno":"","email":"traceydeletetsky@gmail.com","ename":"","eno":"","pphy":"Marcus M Deck","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":"38 Brewster St","madd2":"","madd3":"","mcity":"Bangor","mstate":"ME","mzip":"04401","pcpfaxno":2077984018,"pcpnpi":1891717872,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8TT1EJ2GJ29","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R5381","Z124","R42","R110","I10","M9901","S161XXA","M9904","M9903","M797","Z1231","S76011A","S76312A","I161","R531","R252","M7910","M4607","M9902","H10823","M159","R059","R6889","M5136","L900","N952","R519","M150","S39012A","R1310","K319","K317","J029","S76012A","R2681","R0683","G4710","E785","J45909","J40","K121","R202","H16223","R109","L218","L739","L658","Z7189","M2012","M79672","M2550","M4603","R062","R631","Z0101","Z01419","Z780","H52223","G4733"],"date":["2023-02-28","2023-01-04","2022-11-29","2022-11-29","2024-07-30","2025-06-02","2023-08-07","2025-06-02","2025-06-02","2025-03-17","2024-10-30","2025-06-02","2024-05-06","2022-11-13","2022-11-29","2025-01-14","2025-01-14","2025-04-07","2025-04-07","2022-11-01","2024-03-15","2025-04-15","2023-12-13","2022-11-11","2024-04-09","2024-04-09","2022-11-29","2025-03-17","2024-09-23","2024-02-14","2024-02-14","2024-02-14","2024-02-14","2025-03-20","2022-11-29","2022-08-10","2022-08-10","2024-07-30","2022-11-13","2025-04-19","2022-08-22","2022-11-12","2024-11-18","2022-11-12","2025-07-18","2025-07-18","2025-07-18","2025-07-18","2025-07-14","2025-07-14","2024-05-09","2023-08-07","2025-04-15","2023-04-17","2024-07-09","2023-01-04","2023-01-04","2024-07-09","2022-08-10"],"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":[["","","FLUBLOK QUAD 2022-2023","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","TYRVAYA","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}