{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charlene A Aubert","gend":1,"currentgend":"","add":"203 HILL ST","city":"BIDDEFORD","state":"ME","zip":"04005","dob":"1945-02-03","age":"","mstatus":"","insh":"10000085235","cliId":"","pno":6037671441,"cno":"","email":"claire_agnes45@outlook.com","ename":"","eno":"","pphy":"LETELLIER, TERESA","ppno":2072831441,"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":"203 HILL ST","madd2":"","madd3":"","mcity":"BIDDEFORD","mstate":"ME","mzip":"04005","pcpfaxno":2075231136,"pcpnpi":1629431622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XE1XA1MW09","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":["I447","F330","I509","I5021","E119","I5022","Z950","I3481","I517","I5189","I501","I5023","I420","I951","E611","E559","E7800","F341","I10","F419","I110","R931","F3181","I081","I3139","F5104","F319","Z23","F39","I083","Z0101","N390","Z713","M85852","R531","R791","R5383","K8590","R300","E785","D508","R4182","J984","Z515","I5041","R9431","E1159","H35372","K8050","K8070","R945","K8020","D75839","R079","K9189","R918","R0902","F32A","Z780","K828","F3162"],"date":["2024-11-04","2025-11-03","2024-05-07","2025-10-09","2025-09-09","2025-10-06","2025-09-26","2024-04-05","2024-01-26","2024-01-26","2024-01-26","2025-04-02","2024-08-21","2023-12-16","2023-02-22","2023-02-22","2025-03-21","2025-10-06","2024-03-21","2025-11-07","2024-01-18","2023-12-15","2024-08-02","2024-11-04","2024-11-04","2025-03-06","2025-09-25","2024-10-10","2025-11-07","2023-12-11","2025-07-03","2024-09-03","2024-12-10","2023-04-25","2023-12-18","2023-12-16","2024-09-03","2024-09-03","2024-09-03","2024-08-21","2024-08-21","2024-08-21","2023-12-11","2023-12-12","2023-12-12","2024-08-30","2023-08-17","2024-07-02","2024-09-03","2024-08-01","2024-08-12","2024-07-31","2023-07-13","2024-07-23","2024-08-06","2024-08-05","2024-08-05","2024-08-05","2023-04-25","2024-07-31","2022-11-23"],"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":[["","","BUPROPION XL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}