{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dawn Boutilier","gend":1,"currentgend":"","add":"39 TOWLE ST","city":"Buxton","state":"ME","zip":"04093","dob":"1956-05-10","age":"","mstatus":"","insh":"10000087042","cliId":"","pno":2078076680,"cno":"","email":"dlaboutilier@gmail.com","ename":"","eno":"","pphy":"JOHNSON, JESSICA","ppno":2078392559,"pcpadd":"Martins Point Health Care,575 Main St","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"39 TOWLE ST","madd2":"","madd3":"","mcity":"Buxton","mstate":"ME","mzip":"04093","pcpfaxno":2078287850,"pcpnpi":1477001501,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5WC0U56RD32","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":["M1631","M1712","M21162","M722","I2699","R079","Z6827","E663","Z1231","M9901","M542","M9902","M9903","R1011","Z96641","M1632","M65251","E039","M25552","M546","R109","Z23","R0781","R0602","M549","I4510","M25551","J029","R7401","Z01812","R072","Z86711","Z471","M1611","Z0100","D72828","Z96649","R0789","I517","Z96642","N2889","S76312A","S76311A","M1612","R4182","Z13820","R5383","Z780","R6889","Z13228","Z136","Z13220"],"date":["2023-06-08","2022-12-29","2022-12-29","2022-12-29","2024-07-15","2024-09-17","2024-07-15","2024-07-15","2024-07-11","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2023-10-03","2024-08-12","2025-04-01","2024-08-12","2025-09-09","2025-05-27","2025-11-06","2023-03-21","2023-09-19","2023-09-15","2024-09-16","2023-09-15","2024-09-17","2023-05-17","2025-06-11","2023-08-22","2025-03-10","2024-09-17","2024-09-17","2025-04-14","2023-06-08","2023-11-09","2023-06-17","2023-06-17","2024-09-16","2024-09-17","2025-04-14","2023-10-03","2025-04-01","2025-04-01","2025-04-01","2025-04-01","2024-12-09","2023-07-07","2024-12-09","2022-11-23","2022-09-29","2022-09-29","2022-09-29"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","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":""}]}]}