{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Denise M Libby","gend":1,"currentgend":"","add":"34 OCEAN PARK RD 25","city":"SACO","state":"ME","zip":"04072","dob":"1963-11-11","age":"","mstatus":"","insh":"10000086253","cliId":"","pno":2075025152,"cno":"","email":"dlibb11@gmail.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":"34 OCEAN PARK RD 25","madd2":"","madd3":"","mcity":"SACO","mstate":"ME","mzip":"04072","pcpfaxno":2075231136,"pcpnpi":1629431622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3MC6GQ9VK40","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":["F4310","M25511","G8929","M47816","M47812","M1612","G518","M9901","G43001","M7912","Z87891","R911","Z1231","Z1211","E785","K621","K5730","K648","M9908","M9900","M9902","Z79899","M47814","M62830","M546","I483","Z124","G44209","Z23","D128","K219","R4182","M25752","M25852","F411","Z1212","J869","I499","I4710","L989","J449","G43019","M542","Z0101","Z0184","L720","M25552","J4530","L728","D485","J324","M9907","F419","Z720","R6889","G4733","H5203","R079","J3489","R519"],"date":["2025-11-05","2024-04-22","2024-04-22","2024-11-13","2025-04-22","2025-06-04","2024-05-31","2025-11-10","2025-04-22","2025-04-22","2025-05-27","2024-05-24","2025-06-11","2024-11-18","2025-05-14","2024-11-18","2024-11-18","2024-11-18","2025-09-25","2025-11-10","2025-11-10","2025-05-19","2024-02-12","2024-02-12","2024-02-12","2025-10-24","2023-06-06","2025-04-25","2024-10-31","2024-11-18","2024-11-18","2024-11-18","2025-06-04","2025-06-04","2023-06-06","2024-11-18","2023-11-10","2025-10-24","2025-10-24","2025-04-24","2025-04-24","2025-04-25","2025-04-25","2025-07-09","2024-12-19","2025-06-13","2024-03-15","2022-12-15","2025-04-30","2025-04-30","2024-05-23","2025-11-10","2025-09-18","2025-09-15","2023-07-05","2025-11-08","2024-07-08","2023-11-10","2024-05-23","2025-09-23"],"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":[["","","WIXELA INHUB","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NURTEC ODT","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","AFLURIA QUAD 2023-24 (3YR UP)","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AREXVY","","","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":""}]}]}