{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth N Armstrong","gend":1,"currentgend":"","add":"1 HIGH POINT RD","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1955-10-09","age":"","mstatus":"","insh":"10000085423","cliId":"","pno":2077491397,"cno":"","email":"betts@maine.rr.com","ename":"","eno":"","pphy":"KU RUTH, PHYLLIDIA M","ppno":2077745816,"pcpadd":"100 FODEN RD W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062319","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1 HIGH POINT RD","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":2078741483,"pcpnpi":1497724108,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2MJ6HX4UG41","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M810","M9901","D72819","H903","H6691","M542","Z1231","M25521","Z23","Z20822","R059","R070","J101","M79662","R0781","R0600","M79605","J168","Z0100","I340","M546","L820","Z1211","K635","K648","M50322","M47812","M4312","R519","R1110","J189","E559","Z0001","R6889","H1032","R1032","M549","R079","R053","L608","D2261","L578","R918","H938X1","L570","B009","S20361A","T7029XA","N760","N898","N958","B3731","Z0000","G44229","B349","M1990","Z832","S70362A","R21","C44729","D492","D225","R0789","Z124"],"date":["2024-12-23","2024-11-12","2024-12-23","2025-05-08","2024-11-23","2024-10-24","2024-07-15","2024-10-24","2024-10-24","2024-04-01","2024-04-01","2024-04-01","2025-02-07","2025-04-28","2022-12-20","2022-12-20","2025-04-28","2024-07-18","2024-07-09","2023-01-31","2022-12-20","2024-07-11","2025-05-21","2025-05-21","2025-05-21","2024-10-24","2024-10-24","2024-10-24","2023-03-10","2023-03-10","2024-07-18","2024-12-23","2024-12-23","2023-01-31","2022-10-14","2022-10-30","2022-10-30","2022-10-30","2023-12-14","2022-12-12","2023-06-22","2022-12-12","2024-05-22","2024-12-23","2024-07-11","2023-06-22","2023-06-22","2023-03-10","2024-05-16","2024-05-16","2024-05-16","2024-05-16","2022-12-08","2022-12-08","2022-10-11","2025-04-28","2025-04-28","2022-05-18","2022-05-18","2022-04-14","2022-04-14","2022-04-14","2021-12-02","2022-02-23"],"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":[["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","TERCONAZOLE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","GABAPENTIN","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}