{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth A Marcella","gend":1,"currentgend":"","add":"129 BRICKYARD HILL RD","city":"NORTH BRIDGTON","state":"ME","zip":"04057","dob":"1956-05-08","age":"","mstatus":"","insh":"10000091339","cliId":"","pno":2076327465,"cno":"","email":"lizmarcella@chalmers-realty.com","ename":"","eno":"","pphy":"MOHAN, ELIZABETH A","ppno":"","pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 116","madd2":"","madd3":"","mcity":"NORTH BRIDGTON","mstate":"ME","mzip":"04057","pcpfaxno":"","pcpnpi":1952622151,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4E98T53NN57","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5451","C44311","F418","R4182","H02831","R059","M5136","M25561","R300","J0100","J3489","L570","Z85828","R102","R799","C44629","Z1231","L821","L578","M8580","C44729","R5383","Z23","Z0000","D492","M5127","M47817","M4722","M542","M5412","M329","E7800","Z7952","M351","M8589","Z79899","R0781","S83421A","F329","M9903","M5450","M8588","Z0001","R6889","L989","Z0101","C44320","L820","R208","Z98890","C44329","H0015","Z1321","R6882","N952","F3342","M9900","M9901","M9902","M9904","M9905","R413","E538","D72829","M47816","I878","R1030","K2970","Z124","M9906"],"date":["2023-07-19","2025-04-03","2023-07-19","2023-07-19","2025-01-29","2025-05-19","2023-04-27","2024-01-15","2024-08-08","2024-07-15","2024-07-09","2025-09-30","2025-09-30","2023-03-28","2023-03-28","2025-03-05","2024-10-14","2024-09-30","2023-09-20","2024-02-15","2025-09-16","2023-04-12","2023-02-23","2024-03-08","2025-08-06","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2025-08-28","2025-08-28","2025-08-28","2024-08-29","2024-01-15","2024-01-15","2025-10-02","2023-12-01","2023-12-01","2024-10-31","2025-03-10","2023-11-13","2024-12-20","2025-10-29","2025-06-02","2024-09-30","2024-09-30","2025-06-02","2025-04-02","2024-03-22","2025-02-24","2024-10-31","2024-10-31","2024-10-31","2022-09-28","2022-09-28","2022-09-28","2022-09-12","2022-09-12","2022-08-18","2022-08-18","2022-06-07","2022-05-18","2022-03-25","2022-03-03","2022-02-17","2022-02-17","2022-02-08"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":""}]}]}