{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eileen M King","gend":1,"currentgend":"","add":"11 FIELDCREST RD","city":"WINDHAM","state":"ME","zip":"04062","dob":"1953-10-20","age":"","mstatus":"","insh":"10000088993","cliId":"","pno":2076717829,"cno":"","email":"emmikalonis@gmail.com","ename":"","eno":"","pphy":"SCONTRAS, JENNIFER","ppno":"","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":"11 FIELDCREST RD","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":2075231135,"pcpnpi":1659908101,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XM4VR8FV93","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":["M1712","T8454XD","R002","R310","T8454XA","H33322","H43392","D3132","I2720","R030","I2699","R262","I10","Z471","C541","R110","D252","N838","N840","M79671","M7741","R2241","M25462","D649","L659","C499","K660","N9971","M25562","Z0189","M79605","R600","R0602","M25532","S52552D","T8459XA","M65862","S52552A","R0789","R0609","I2510","Z96652","I499","Z96659","R2689","T84023A","M01X62","N6489","H43813","R008","I509","R079","K828","R928","R0600","R42","M79632","S63522A","Z1231","M79642","I2584","Z86718","M7989","Z13228","E785","T84023D","Q2381","R509","T8189XA","R519","R011","R4182","N390","Z736","S63522D","Z452","R001","R0902","S83005A","Z96642","M25362","S52572A","G8918","R300","D251","N736","Z01812","R946","Z23","R350","M899","R945","L0889","R000","Q231","R61","Z90710","J9811","R32","Z13220","Z0000","R269","Z780","I5032","I7300","M151","R760","I088","N841","D259","R9389","N950","Z85831","Z85068","R102","Z1151","Z01419","Z124","I6523","H9313","D487","H5712","H35412","Z86011","Z136"],"date":["2024-11-20","2024-12-31","2023-02-01","2024-02-08","2024-12-16","2025-08-18","2025-07-14","2025-07-14","2024-04-03","2023-12-11","2024-09-07","2024-08-04","2024-02-22","2024-09-11","2024-01-23","2024-02-22","2022-12-08","2022-12-08","2022-12-08","2024-01-29","2024-01-29","2024-01-29","2024-07-27","2025-03-07","2025-03-07","2023-01-06","2022-12-08","2022-12-08","2025-01-16","2025-03-07","2024-08-13","2024-08-13","2024-02-02","2023-09-11","2023-09-11","2025-02-19","2024-10-17","2023-09-11","2024-05-06","2024-05-03","2025-09-30","2025-08-11","2024-10-31","2024-12-04","2024-10-15","2024-11-18","2024-04-17","2024-01-29","2024-01-22","2024-05-06","2025-01-04","2024-02-02","2024-02-05","2024-01-29","2023-01-12","2022-12-11","2023-07-11","2023-07-11","2024-01-15","2023-07-11","2024-09-04","2024-08-13","2024-08-13","2023-12-27","2023-12-27","2024-08-05","2025-09-30","2024-10-16","2024-10-16","2022-12-08","2022-12-08","2022-12-08","2024-08-04","2024-08-05","2023-07-25","2024-04-03","2024-09-05","2024-02-02","2024-07-27","2024-07-27","2024-07-27","2023-08-08","2024-12-16","2024-01-30","2022-12-08","2022-12-08","2024-01-19","2025-10-07","2024-01-02","2025-10-07","2024-12-04","2025-10-07","2025-02-20","2023-02-27","2023-02-27","2024-01-23","2024-01-23","2023-03-06","2023-03-07","2025-06-16","2025-10-07","2024-11-07","2023-12-12","2024-08-05","2022-11-15","2022-11-15","2022-11-15","2022-10-26","2022-11-08","2022-10-25","2022-11-08","2022-11-08","2022-11-08","2022-11-18","2022-10-25","2022-11-08","2022-11-08","2022-11-08","2022-11-16","2022-11-16","2022-10-11","2022-10-11","2022-09-19","2022-08-23","2022-08-08"],"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":[["","","ONDANSETRON ODT","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","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":""}]}]}