{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"June M Teras","gend":1,"currentgend":"","add":"280 LONGFELLOW ST APT 27","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1954-08-23","age":"","mstatus":"","insh":"10000092866","cliId":"","pno":2077122758,"cno":"","email":"jteras54@gmail.com","ename":"","eno":"","pphy":"FAY SHIELDS, JACOB A","ppno":2078392559,"pcpadd":"Martins Point Health Care,575 Main St","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"280 LONGFELLOW ST APT 27","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":2075231135,"pcpnpi":1467038042,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2M21WD4UK20","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I5181","T8092XA","I214","I5021","J8410","J189","K7460","N390","Z1231","R918","R000","R0682","R748","I2510","R931","N644","Z0101","E7800","S79911A","S4982XA","K760","J984","R162","E119","I499","R079","R0602","F10920","F17210","I080","R7989","Z23","S199XXA","R300","R945","D7589","S0990XA","J449","R0902","S3991XA","S3993XA","S299XXA","R109","S6992XA","R932","K7689","R6889","E1165","R739","J0190","I10"],"date":["2025-09-17","2023-06-05","2025-09-19","2025-10-07","2025-09-15","2025-09-15","2023-05-08","2025-05-08","2023-08-22","2025-09-15","2025-09-17","2025-09-17","2023-01-16","2025-09-18","2025-09-18","2025-03-10","2025-04-15","2025-10-30","2023-06-04","2023-06-04","2023-01-31","2025-06-09","2023-03-02","2025-10-01","2025-09-17","2025-09-20","2025-09-17","2023-06-05","2023-06-05","2025-09-17","2023-01-18","2025-05-08","2023-06-05","2025-05-08","2023-01-16","2023-01-16","2023-06-05","2025-08-12","2025-09-19","2023-06-05","2023-06-05","2023-06-05","2025-09-20","2023-06-05","2022-10-03","2022-10-03","2022-09-23","2022-09-26","2022-08-31","2022-03-04","2022-03-04"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","ACCU-CHEK GUIDE TEST STRIP","","","Select","Select",""],["","","ACCU-CHEK GUIDE ME GLUCOSE MTR","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ACCU-CHEK SOFTCLIX","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","GLIMEPIRIDE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ONETOUCH VERIO FLEX METER","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","AZITHROMYCIN","","","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":""}]}]}