{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ingeborg L Endter","gend":1,"currentgend":"","add":"6 MERRITT HOUSE RD 11","city":"ORRS ISLAND","state":"ME","zip":"04066","dob":"1944-07-22","age":"","mstatus":"","insh":"10000086926","cliId":"","pno":6176998380,"cno":"","email":"iendter@alum.mit.edu","ename":"","eno":"","pphy":"WHITE, SARAH B","ppno":2077984400,"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":"6 MERRITT HOUSE RD 11","madd2":"","madd3":"","mcity":"ORRS ISLAND","mstate":"ME","mzip":"04066","pcpfaxno":"","pcpnpi":1063702819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2YD5P44PJ50","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":["B351","M79674","M79675","F331","I10","K760","M8580","Z13220","K529","M25462","L820","E039","G4733","R0683","Z0101","H524","H52223","H5203","H70003","Z23","D492","H04123","Z961","I351","R609","D729","R7301","R7401","D7589","J849","F1010","J324","J342","B353","F330","K429","E559","J320","R7989","M25561","M25562","M62838","M170","M25461","J4520","J323","J322","M1909","H7090","I700","R051","G4710","R42","H818X2","Z13820","R9089","J329","L989","R600","E785","J189","J45909","R059","R509","I517","K219","I080","I77810","H7013","M2042","L723","R140","Z780","E538","E8342","F329","R748"],"date":["2025-10-30","2025-10-30","2025-10-30","2025-08-26","2025-11-05","2025-09-15","2024-06-05","2024-06-05","2025-09-15","2025-08-12","2024-02-20","2025-06-16","2024-05-15","2024-05-15","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2024-04-18","2025-11-03","2024-02-20","2025-08-19","2025-08-19","2025-11-05","2025-11-05","2025-09-11","2024-09-13","2025-06-23","2024-06-11","2024-02-07","2024-09-13","2024-04-18","2024-04-18","2024-10-15","2024-10-31","2023-08-22","2025-06-16","2024-01-06","2025-06-16","2025-08-16","2025-08-16","2023-09-19","2025-08-12","2025-08-12","2024-02-07","2024-01-30","2024-01-30","2024-01-30","2024-01-30","2025-02-22","2025-02-22","2023-10-12","2023-08-10","2023-06-26","2023-07-31","2023-08-10","2023-08-10","2024-01-26","2025-07-21","2023-06-28","2025-02-22","2025-02-22","2025-02-22","2025-02-22","2025-02-22","2025-06-09","2025-07-21","2025-07-21","2024-01-30","2023-09-26","2024-11-07","2025-06-23","2023-07-31","2023-11-06","2023-11-06","2022-09-13","2022-08-31"],"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":[["","","LOPERAMIDE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","DESVENLAFAXINE SUCCINATE ER","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DESVENLAFAXINE ER","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y 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":[]}},{"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":""}]}]}