{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gail F Reeve","gend":1,"currentgend":"","add":"74 RUNNING HILL RD APT 341","city":"S PORTLAND","state":"ME","zip":"04106","dob":"1941-03-04","age":"","mstatus":"","insh":"10000085098","cliId":"","pno":2075587915,"cno":"","email":"","ename":"","eno":"","pphy":"LANG, KRISTEN","ppno":2078282402,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"74 RUNNING HILL RD APT 341","madd2":"","madd3":"","mcity":"S PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078282433,"pcpnpi":1598298697,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9GQ5RQ2RD53","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":["G4733","H5340","H35363","I639","R410","Z13228","Z136","Z23","I480","Z130","Z13220","L821","Z85828","D229","Z0100","J069","N390","R4701","F0390","Z8679","I629","I4891","Z006","I618","I619","R200","S0011XA","I10","E785","K219","E871","I4892","Z95818","Z538","S199XXA","S0990XA","Z780","I371","D1803","J9811","Z95811","L409","Z79899","S06310A","S91104A","H6122","I9581","L570","S300XXA","G4730","G936","H547","I2510","S06310D"],"date":["2025-11-06","2025-05-01","2024-11-19","2025-04-08","2025-04-11","2024-09-25","2024-09-25","2024-10-03","2025-11-04","2024-09-25","2024-09-25","2025-05-27","2025-05-27","2025-05-27","2024-03-25","2023-03-18","2023-12-13","2025-04-08","2025-04-11","2025-04-11","2025-01-07","2024-07-31","2023-09-07","2025-01-30","2025-01-07","2023-09-22","2025-06-15","2023-10-18","2023-09-07","2025-01-30","2025-01-30","2023-10-18","2023-10-18","2023-10-18","2025-06-15","2025-06-15","2023-11-08","2023-09-07","2023-09-07","2023-09-07","2023-10-18","2025-01-30","2025-01-03","2025-01-07","2025-10-17","2024-03-19","2023-09-07","2023-05-16","2023-05-22","2023-10-18","2025-01-06","2025-01-06","2024-07-31","2025-01-07"],"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":[["","","MEMANTINE HCL ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","DONEPEZIL HCL","","","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":""}]}]}