{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pattijean Gerrish","gend":1,"currentgend":"","add":"665 SACO ST LOT 245","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1956-03-17","age":"","mstatus":"","insh":"10000093265","cliId":"","pno":2076501443,"cno":"","email":"pgerrish1@maine.rr.com","ename":"","eno":"","pphy":"CAREY, SEAN P","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":"665 SACO ST LOT 245","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":2075231135,"pcpnpi":1447328125,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4DD2AA8DW28","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":["E1165","G4733","M47816","M160","M25559","M7060","D123","Z4509","E119","S7291XA","D649","W19XXXA","E785","Q2112","S39012A","M25551","S7291XS","M25651","R262","Z4889","I6523","I480","I4819","R4701","I358","R7401","Z23","G459","J0190","Z0101","R140","T1490XA","Z743","K5900","J208","B9789","R519","Z7982","Z01818","R0602","S72141A","R1084","Z1231","G4709","Z86010","K5730","M8588","Z20822","S72001A","W1830XA","R109","R6889","S72101A","I253","I083","M85852","Z780","G8929","S72001D","X503XXA","Y9353","M79604","S7221XA","J069","R42","K760","K8020","R918","R000","R0981","M25552","M7062","M5450"],"date":["2024-05-20","2025-11-13","2023-11-02","2024-11-06","2022-12-22","2023-11-02","2023-10-24","2025-11-03","2025-08-05","2025-05-08","2025-05-08","2025-05-05","2025-07-07","2025-06-26","2023-07-13","2025-08-27","2025-06-03","2025-08-27","2025-08-27","2025-08-27","2024-06-03","2025-08-05","2025-08-13","2024-01-25","2024-01-02","2023-12-11","2024-12-02","2025-08-05","2024-08-28","2024-12-27","2023-07-20","2025-05-01","2025-05-01","2025-05-07","2024-08-26","2024-08-26","2024-08-26","2024-08-26","2025-05-01","2025-05-01","2025-05-01","2023-03-21","2024-12-02","2024-08-07","2023-10-24","2023-10-24","2022-12-19","2023-08-23","2025-05-01","2025-05-01","2025-05-07","2023-12-18","2025-05-01","2024-01-17","2024-01-17","2022-12-19","2022-12-19","2023-11-02","2025-06-20","2023-07-13","2023-07-13","2025-05-22","2025-05-01","2024-03-24","2025-08-05","2023-07-20","2023-07-20","2024-08-26","2025-05-05","2025-01-21","2022-11-02","2022-11-02","2022-11-02"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY READER","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)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":{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}