{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ann M Roy","gend":1,"currentgend":"","add":"226 LITTLEFIELD VILLAGE RD","city":"Ogunquit","state":"ME","zip":"03907","dob":"1948-02-14","age":"","mstatus":"","insh":"10000092794","cliId":"","pno":2073517078,"cno":"","email":"grammyroy@gmail.com","ename":"","eno":"","pphy":"CORBETT, SANDRA L","ppno":"","pcpadd":"127 LONG SANDS RD,SUITE 11","pcpcity":"YORK","pcpstate":"ME","pcpzip":"39091158","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 2207","madd2":"","madd3":"","mcity":"Ogunquit","mstate":"ME","mzip":"03907","pcpfaxno":2073513006,"pcpnpi":1417910019,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9KY6YV2CK46","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":["F322","M1711","M6281","M25562","L821","L298","R209","L814","D485","D0471","L818","M179","Z1231","L570","L578","L728","D0439","J209","Z471","H353122","H353111","D3131","H43811","D049","Z7189","Z872","H02885","R6889","K219","G8929","K2100","Z01818","B078","L538","X32XXXA","D0472","N8111","H00021","R918","I700","R059","H353133","H353220","H04123","G8918","D2371","H25812","H25811","H25813","H43813","H1033","M1611","Z4689","F1021","M150","F325","E663","D2339","D225","J986","I771","M8589","Z96651","E785","L918","R1314","Z1211","L820","B349","Z20822","N819","N905","B079","K222","Z86010","D123","H3530","K2090","Z0000","M1990","U071","D2271","D2362","R351"],"date":["2025-09-30","2024-07-17","2023-05-23","2023-01-12","2025-03-05","2024-09-04","2025-03-05","2025-03-05","2025-03-05","2024-04-03","2024-03-06","2024-09-04","2025-05-21","2025-04-02","2025-07-09","2023-01-25","2025-04-02","2023-04-03","2025-07-01","2025-08-26","2025-08-26","2024-12-17","2024-12-17","2025-07-09","2025-07-09","2025-07-09","2024-04-10","2023-07-10","2025-01-10","2025-06-17","2025-07-22","2024-07-09","2023-11-08","2023-11-08","2024-02-07","2023-11-08","2025-06-03","2023-07-24","2024-06-06","2024-06-06","2025-01-14","2023-08-10","2024-08-12","2024-02-21","2024-07-17","2024-09-04","2025-09-12","2025-09-12","2025-09-12","2025-09-12","2024-02-02","2024-06-27","2024-10-01","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-12-06","2025-03-05","2024-07-09","2024-07-09","2023-04-25","2025-07-01","2024-12-12","2024-02-07","2025-07-22","2025-07-22","2023-11-08","2025-01-14","2025-01-14","2023-01-03","2023-01-03","2023-10-04","2022-11-15","2022-11-15","2022-11-15","2022-11-09","2022-11-15","2022-10-11","2022-10-11","2022-09-16","2022-09-28","2022-09-28","2022-08-30"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TOBRAMYCIN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","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":""}]}]}