{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cheryl J Carlomagno","gend":1,"currentgend":"","add":"109 RIDGELAND AVE APT 318","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1954-11-20","age":"","mstatus":"","insh":"10000088350","cliId":"","pno":2072325757,"cno":"","email":"Chericarlomagno17@gmail.com","ename":"","eno":"","pphy":"KNIGHT, CARLEEN R","ppno":2077986200,"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":"109 RIDGELAND AVE APT 318","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2077986290,"pcpnpi":1043589443,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6WG4VM2RJ71","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":["F333","R4182","R0602","T7840XD","E440","K5903","E785","M810","Z4682","J939","J930","S2241XA","S22009A","R296","F323","T391X1A","E46","F418","S299XXA","L910","J45909","S2241XD","F451","S0181XA","S0011XA","W19XXXA","S270XXA","F209","Z1231","H0288A","F4322","D225","Z85828","L821","L570","F459","K712","F419","E870","R109","E873","F339","S3991XA","S3993XA","Z1211","E876","E612","S199XXA","S0990XA","E43","R188","S36119A","S36119D","M1990","H35373","S0083XA","M51360","M47816","M9900","M9901","M9902","R519","W1839XA","M9909","M8589","Z681","F4310","F22","R569","H40013","S22079A","F331","J0190","R630","M546","Z23","R1084","R6889","F309","T7840XA","K56609","N281","D1801","B179","J189","R7989","E871","F32A","R197","M7910","R059","Z20822","R7401","M8588","R350"],"date":["2024-04-17","2023-11-03","2023-07-26","2023-11-03","2023-08-09","2023-08-09","2025-01-27","2025-07-08","2023-05-26","2023-05-26","2023-05-22","2023-05-27","2023-05-22","2023-05-21","2023-11-03","2023-06-06","2023-06-02","2023-09-27","2023-05-21","2025-08-19","2023-11-03","2023-08-07","2024-03-26","2024-02-16","2024-02-16","2024-02-16","2023-05-27","2023-02-20","2025-05-27","2022-12-15","2025-05-29","2023-02-15","2023-02-15","2023-02-15","2025-05-27","2023-05-08","2023-06-05","2024-03-26","2023-01-05","2023-06-06","2023-06-05","2023-11-03","2023-05-21","2023-05-21","2023-11-28","2023-05-25","2023-05-25","2023-05-21","2023-05-21","2023-08-09","2023-05-27","2023-05-27","2023-06-06","2023-07-10","2023-12-06","2024-02-16","2025-01-07","2025-01-07","2023-07-21","2023-07-21","2023-07-21","2023-06-16","2024-02-16","2023-08-09","2024-10-08","2023-05-07","2023-05-07","2023-10-09","2023-05-26","2024-12-09","2023-05-27","2023-01-30","2024-03-19","2023-05-16","2023-07-21","2024-01-16","2023-05-18","2022-11-03","2023-01-21","2023-09-27","2023-05-30","2023-05-16","2025-08-19","2023-05-28","2022-10-29","2022-10-29","2022-10-27","2022-10-29","2022-10-28","2022-10-27","2022-10-27","2022-10-27","2022-11-10","2022-10-04","2022-08-17"],"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":[["","","BOOSTRIX TDAP","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","LACTULOSE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ABILIFY MAINTENA","","","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":""}]}]}