{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elana M Wyman Koehling","gend":1,"currentgend":"","add":"47 FLORAL ST APT 311","city":"BATH","state":"ME","zip":"04530","dob":"1965-06-16","age":"","mstatus":"","insh":"10000081127","cliId":"","pno":2076072681,"cno":"","email":"emj161965@gmail.com","ename":"","eno":"","pphy":"FLORY, ELIZABETH","ppno":2077984400,"pcpadd":"Martins Point Health Care,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"47 FLORAL ST APT 311","madd2":"","madd3":"","mcity":"BATH","mstate":"ME","mzip":"04530","pcpfaxno":2077984018,"pcpnpi":1659865970,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7DR6T44HH30","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F4310","F410","F419","M79672","M25672","S92812A","R269","S82872K","Z0101","H04123","Z1211","N3941","J343","Z1231","Z1212","K621","K5730","I10","R0981","Z1159","D492","R0982","K219","F331","J329","Z639","F32A","F840","Q6672","Q6671","Z113","Z114","R413","Z79891","M25511","R140","S8292XA","J020","R079","Q6652","Q6651","Z0100","J342","M19072","N62","L814","H52223","H524","R102","S82872D","Z01419","R002","G8918","T8484XA","F418","T7491XS","R7303","M25572","Y792","U071","B351","Z13220","Z136","M2140","M2040","M7740","R262","G4730"],"date":["2025-01-30","2025-08-26","2025-06-25","2025-01-16","2025-01-16","2025-01-16","2025-01-16","2024-10-04","2025-01-30","2025-01-30","2025-03-31","2024-10-10","2025-08-04","2025-09-02","2025-03-31","2025-03-31","2025-03-31","2025-04-24","2025-09-04","2025-04-24","2025-01-16","2025-08-04","2025-08-04","2025-08-26","2025-08-04","2025-08-26","2025-08-26","2025-03-13","2023-10-24","2023-10-24","2023-05-05","2023-05-05","2024-05-12","2025-04-24","2025-08-25","2024-10-10","2023-12-12","2023-10-27","2023-12-25","2024-03-08","2024-03-08","2024-02-13","2025-04-15","2025-08-22","2025-08-22","2025-01-16","2025-01-30","2025-01-30","2024-07-09","2023-10-13","2024-07-08","2023-09-07","2023-09-28","2023-09-28","2025-03-31","2024-10-31","2023-05-05","2023-09-28","2023-09-28","2023-12-24","2024-05-16","2023-05-05","2023-05-05","2023-11-16","2023-11-16","2023-11-16","2023-11-16","2025-03-31"],"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":[["","","ALPRAZOLAM","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AFLURIA TRIV 2024-25 (3YR UP)","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","CICLOPIROX","","","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":""}]}]}