{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbara J Keene","gend":1,"currentgend":"","add":"412 COLE HILL RD","city":"STANDISH","state":"ME","zip":"04084","dob":"1954-03-02","age":"","mstatus":"","insh":"10000082935","cliId":"","pno":2073182684,"cno":"","email":"bkeene4494@gmail.com","ename":"","eno":"","pphy":"ACHILLE, JUSTINE","ppno":2078392559,"pcpadd":"Martins Point Health Care,PO Box 9746","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04104","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"412 COLE HILL RD","madd2":"","madd3":"","mcity":"STANDISH","mstate":"ME","mzip":"04084","pcpfaxno":2075231135,"pcpnpi":1962962324,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2KN1FG4DK27","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":["S93401D","F3181","F410","F4323","Z7189","N816","Z0101","Z1231","J45909","I10","G4730","D3131","S93401A","S93601A","X501XXA","E538","E785","M810","R195","M47817","M19071","M47814","Z23","K5730","Z13820","R051","G4700","E559","R1084","K635","Z86010","R6889","M546","M5450","Z780","Z1211","F411"],"date":["2023-09-29","2025-10-16","2025-10-16","2025-10-16","2025-10-16","2025-10-23","2025-05-07","2024-05-20","2025-10-23","2025-10-23","2025-10-23","2025-05-07","2023-07-30","2023-07-30","2023-07-30","2025-05-02","2025-05-02","2025-05-02","2023-09-06","2025-04-25","2023-07-30","2025-04-25","2023-02-03","2025-08-24","2023-07-05","2025-11-03","2025-11-03","2023-07-26","2025-08-24","2023-10-02","2023-10-02","2023-05-26","2025-04-25","2025-04-25","2023-07-05","2023-10-02","2022-08-23"],"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":[["","","TRAMADOL HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":""}]}]}