{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karan E Troy","gend":1,"currentgend":"","add":"148 BREAKWATER DR UNIT 508","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1954-02-20","age":"","mstatus":"","insh":"10000087365","cliId":"","pno":2075904164,"cno":"","email":"KETZ2100@gmail.com","ename":"","eno":"","pphy":"CONNOLLY, MARY J","ppno":2078741489,"pcpadd":"100 FODEN RD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"148 BREAKWATER DR UNIT 508","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078741483,"pcpnpi":1558535559,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2GX0G79VY16","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E063","M85852","R739","H33311","H43811","H43812","H2513","L900","N952","H33301","H43813","H04123","Z0101","N904","R350","E7800","Z0184","J209","H66001","M25562","M2560","M6281","M25469","Z0001","R944","Z1231","R059","J069","H6690","M799","R7989","M62552","M8588","N9089","L570","Z0000","H33333","R2242","M25572","M1612","M8580","Z131","Z23","Z1211","E038","X501XXA","E785","E559","U071","Z20822","J029","R519","D492","L720","R52","D485","L308","L659","L910","D225"],"date":["2024-06-10","2025-08-19","2025-06-17","2023-11-09","2023-11-09","2023-11-09","2023-11-21","2024-06-13","2024-06-13","2023-11-21","2023-11-21","2023-11-21","2025-10-20","2024-06-13","2024-06-19","2025-08-19","2023-02-23","2023-10-08","2023-10-08","2023-01-16","2023-01-16","2023-01-16","2023-01-16","2025-06-17","2024-06-19","2024-05-02","2023-10-12","2023-10-12","2023-10-12","2025-07-11","2025-06-17","2025-06-27","2025-01-06","2024-06-13","2024-05-23","2025-06-17","2024-02-05","2025-07-11","2025-06-27","2025-06-27","2025-01-06","2024-06-10","2022-11-22","2022-11-22","2022-11-22","2022-11-11","2022-11-16","2022-11-16","2022-06-08","2022-05-28","2022-05-28","2022-05-28","2022-04-21","2022-04-22","2022-04-21","2021-11-10","2021-11-10","2022-01-31","2022-01-31","2022-01-31"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}