{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jennifer V Berry","gend":1,"currentgend":"","add":"7 HIGHWOOD ST","city":"Waterville","state":"ME","zip":"04901","dob":"1985-12-07","age":"","mstatus":"","insh":"10000090675","cliId":"","pno":2078778967,"cno":"","email":"declined@06042025.com","ename":"","eno":"","pphy":"MOREAU, SHANNON N","ppno":2072831441,"pcpadd":"Martins Point Health Care,61 Barra Rd","pcpcity":"Biddeford","pcpstate":"ME","pcpzip":"04005","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 HIGHWOOD ST","madd2":"","madd3":"","mcity":"Waterville","mstate":"ME","mzip":"04901","pcpfaxno":2075231136,"pcpnpi":1629337902,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7HH6ND3UQ57","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":["E876","G4733","R410","N319","R6884","R109","E6601","Z6843","G809","H53001","R55","T7840XA","R0602","N318","K3184","E119","R45851","M25552","T7800XA","R1032","K5900","F603","F4310","F419","H40013","H52203","D3132","H538","R5381","Z113","R1031","F411","N3281","N3289","T8389XA","R2689","R531","T83010A","I10","K219","R0683","T8131XA","F332","F32A","R441","K0889","R079","Z98890","N952","N809","Z90722","N951","K029","E668","H6691","K135","Z6841","K5909","H52213","R6889","K068","K08409","R350","K222","R194","R159","J45909","R4182","F39","U071","Z743","Z993","H548","R0789","R110","Z6842","F341","T83511A","R202","R309","M5489","N390","R1011","J189","R1084","E089","H9210","H9209","F329","F339","F99","Z9049","M1990","R300","Z01419","Z0001","G40A09","Z760","H6990","R569","T1491XA","T50902A","B351","M79671","M79672","I70203","E7871","Z5321","E28319","Z62810","T83510A","R7401","F4320","R197","F29","R1012","R112","Z1151","R1030","K5641","T839XXA","R339","T83098A","R519","Z79899","E889","R45850","F333","R440","B3789","G894","B372","F331","R9431","Z136","T83518A","R1310","T424X2A","R4689","G808","R4589","T83038A","L299","R443","R3989","Z9989","M79602","M549","G43709","L03311","K581","A000","G8929","N23","K921","L03116","F23","F319","H11431","G800","T24211A","R269","R200","T24011A","T23001A","N3000","F4321","Z960","T50904A","K047","R070","E1140","K1379","K122","M7918","R0681","J3489","K319","K625","K2289","K317","K3189","Z23","R945","J4520","G43909","R4586","G479","Z634","E221","E8881","Z124","B373","R6339","Z01812","Z20822","N898","G801","R42","N3090","M79604","M79605","R600","M79662","M79661","G629","R609","R399","R310","R338","Z13220","E559","G8190","F449","R0600","R509","R4781","Z20828"],"date":["2024-06-09","2024-01-16","2024-02-28","2025-07-01","2023-03-04","2025-09-28","2023-07-05","2023-01-23","2025-11-13","2025-11-13","2023-04-03","2024-06-06","2024-06-06","2023-07-21","2023-08-04","2023-07-16","2025-10-22","2024-06-12","2023-04-03","2025-09-06","2025-09-28","2025-07-21","2025-10-22","2025-09-16","2025-09-04","2023-04-28","2025-09-04","2025-05-07","2024-06-12","2024-06-01","2024-05-08","2025-11-09","2023-03-17","2023-03-17","2023-03-17","2025-08-10","2024-02-28","2023-03-17","2025-08-09","2023-03-17","2022-12-05","2023-03-05","2025-07-21","2025-10-22","2025-10-28","2023-03-07","2025-11-09","2023-03-05","2023-04-03","2023-01-03","2023-01-03","2023-04-03","2023-02-22","2023-04-05","2025-10-22","2023-02-22","2023-07-05","2023-05-31","2025-05-07","2025-09-29","2023-03-04","2023-03-04","2025-10-17","2023-02-10","2023-02-10","2023-02-10","2023-09-08","2024-04-03","2024-06-04","2023-01-03","2025-07-22","2023-02-22","2023-02-22","2025-11-08","2025-11-08","2022-11-30","2024-07-10","2024-08-15","2023-04-04","2025-09-06","2025-09-06","2024-08-15","2024-07-30","2023-01-02","2025-09-16","2024-07-30","2025-08-09","2025-08-09","2025-07-16","2025-07-21","2024-08-25","2025-09-06","2023-03-26","2025-09-06","2025-08-20","2025-08-20","2025-08-28","2025-08-28","2025-08-09","2025-08-28","2024-07-26","2024-08-04","2025-07-30","2025-07-30","2025-07-30","2025-07-30","2025-09-04","2024-08-16","2023-04-03","2023-04-03","2024-08-16","2023-04-17","2025-06-24","2025-09-16","2025-08-30","2025-09-16","2025-09-16","2025-08-20","2025-09-28","2025-09-28","2024-10-17","2024-10-29","2024-10-17","2023-11-19","2025-07-11","2025-07-11","2025-07-15","2024-02-27","2023-09-25","2023-08-31","2023-09-08","2024-03-01","2023-09-08","2023-11-20","2023-11-20","2023-11-30","2023-05-31","2023-09-14","2024-04-04","2023-08-02","2024-03-01","2024-03-01","2023-06-29","2023-09-26","2023-09-26","2023-06-27","2023-09-17","2024-02-28","2023-09-08","2023-05-16","2023-07-21","2023-12-03","2023-07-11","2024-01-26","2023-10-12","2023-10-12","2024-03-30","2023-03-10","2024-04-20","2023-04-13","2024-04-20","2023-09-26","2023-06-29","2024-04-20","2024-04-20","2023-09-09","2024-04-25","2023-07-11","2024-01-30","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-11-14","2022-11-11","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-09-19","2022-09-14","2022-08-10","2022-08-10","2022-08-14","2022-08-11","2022-08-04","2022-07-06","2022-07-06","2022-05-31","2022-05-31","2022-05-11","2022-05-08","2022-05-08","2022-04-20","2022-04-14","2022-04-14","2022-04-07","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2021-11-12","2021-12-02","2022-01-10","2022-01-21","2022-01-21","2022-01-23","2022-01-23","2022-01-23","2022-01-23","2022-01-23","2022-01-23"],"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":[["","","ATENOLOL","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","VENLAFAXINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","AMITIZA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","OLANZAPINE ODT","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","LINZESS","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","PROMETHAZINE HCL","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","DOTTI","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","RENACIDIN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","YUVAFEM","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","TRULANCE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","LACTULOSE","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}