{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth A Farrell","gend":1,"currentgend":"","add":"527 CUSHMAN RD LOT 2","city":"Winslow","state":"ME","zip":"04901","dob":"1950-12-26","age":"","mstatus":"","insh":"10000083951","cliId":"","pno":2072133832,"cno":"","email":"nyfarrells1971@gmail.com","ename":"","eno":"","pphy":"CAREY, SEAN P","ppno":2078392559,"pcpadd":"Martins Point Health Care,575 Main St","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"527 CUSHMAN RD LOT 2","madd2":"","madd3":"","mcity":"Winslow","mstate":"ME","mzip":"04901","pcpfaxno":2075231135,"pcpnpi":1447328125,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7PP6CQ9GU55","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":["Z510","C3411","I422","F17210","G4733","C3490","D6959","T451X5A","C3491","Z862","Z9221","J439","R590","I2510","I10","J449","Z5111","Z01810","H2512","Z122","R0602","R0600","Z79899","D539","Z87891","N289","D649","I080","R918","Z85118","Z923","D696","R7989","R059","N189","K31811","K922","H02822","H02824","R911","G4734","D704","R0683","E669","Z6833","Z7951","K5730","R932","K429","R935","Z08","Z1159","Z9989","Z01811","Z98890","Z0101","H2513","H5213","H524","H52223","J209","J440","Z1152","R0789","H2511","H539","D464","K625","R5383","D729","D509","I6523","I998","K449","J479","Z09","K921","K640","R1011","R6889","K219"],"date":["2024-06-17","2025-07-22","2025-02-11","2024-06-06","2025-11-13","2025-11-06","2024-08-21","2024-08-21","2025-03-12","2025-01-07","2025-04-16","2025-02-19","2025-02-19","2025-05-29","2025-07-10","2025-07-10","2024-09-17","2024-05-09","2025-10-06","2024-02-02","2024-05-22","2024-05-22","2025-08-05","2025-04-16","2024-02-02","2025-02-04","2025-02-04","2025-05-13","2024-04-19","2025-07-10","2025-04-16","2024-09-17","2024-07-31","2024-05-01","2024-05-28","2025-02-12","2025-02-12","2023-05-02","2023-05-02","2024-11-19","2025-10-26","2025-01-10","2024-06-24","2024-06-24","2024-06-24","2024-03-01","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-07-24","2024-06-25","2025-01-13","2024-04-19","2024-04-19","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2023-10-02","2023-10-02","2023-10-02","2024-10-23","2025-10-20","2024-09-04","2024-12-19","2023-06-06","2023-10-12","2023-10-12","2025-11-07","2024-12-17","2024-03-11","2025-05-29","2025-05-29","2023-09-14","2023-12-19","2023-12-19","2024-11-13","2022-11-22","2022-08-29"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","VERAPAMIL SR","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","COMBIVENT RESPIMAT","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","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":""}]}]}