{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia J Pineo","gend":1,"currentgend":"","add":"3 LONG SWAMP RD","city":"Berwick","state":"ME","zip":"03901","dob":"1951-03-27","age":"","mstatus":"","insh":"10000093453","cliId":"","pno":6035343310,"cno":"","email":"trishjoi.pp@gmail.com","ename":"","eno":"","pphy":"BOONE, EMILY ANNE B","ppno":"","pcpadd":"\tMartins Point Health Care,\t161 Corporate Dr","pcpcity":"Portsmouth","pcpstate":"NH","pcpzip":"03801","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 LONG SWAMP RD","madd2":"","madd3":"","mcity":"BERWICK","mstate":"ME","mzip":"03901","pcpfaxno":6039454339,"pcpnpi":1952962623,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5GY5GT3PT82","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":["M7071","M25521","G5681","M25511","S3282XA","G894","M47816","Z79891","H25812","H25811","H25813","E611","Z1231","K429","S3289XA","R102","E039","M461","N390","M479","S3282XD","M47817","R350","R300","R3915","S32810D","W19XXXD","I10","S3722XA","M7918","L570","L821","L814","D229","L578","D485","S3210XA","S32591A","S32511A","S329XXA","D235","M160","M5459","E782","R42","R9431","S3722XS","W19XXXS","M8580","R936","T1490XA","S32591D","S32501D","R269","M25551","M8589","M810","Z79899","M85852","Z7189","M25552","I4710","I480","I6529","M1711","Z20822","W19XXXA","G43909","H2511","G8929","K219","H2512","M170","M47819","R0609","R339","W000XXA","S43401A","M67813","M19011","M1712","N952","S3722XD","E785","S3219XD","S322XXD","S43431A","R928","E2839","G589","I208","M609","R202","R2231","M19021","R001","I4720","G540","M5412","M4722","M7711","I471","N10","I472","A4151","R0602","R071","I358","R509","K439","K449","R109","R110"],"date":["2023-08-16","2025-11-13","2023-04-03","2023-07-20","2023-07-20","2024-03-01","2025-11-13","2025-11-13","2024-01-23","2024-01-16","2023-12-11","2025-09-08","2025-07-14","2024-12-04","2023-02-02","2023-02-02","2025-09-26","2024-03-01","2024-06-14","2023-08-17","2023-08-17","2023-08-23","2023-12-09","2023-12-09","2023-12-09","2023-02-16","2023-02-16","2025-09-10","2023-01-28","2023-05-30","2025-08-06","2025-08-06","2025-08-06","2025-08-06","2025-08-06","2025-08-06","2023-01-24","2023-01-24","2023-01-24","2023-01-25","2025-08-06","2025-01-02","2025-01-02","2023-05-26","2025-04-03","2023-10-13","2023-01-28","2023-01-28","2023-01-28","2025-04-29","2023-01-24","2023-05-01","2023-02-09","2023-02-09","2024-03-21","2025-09-04","2023-05-26","2023-10-12","2023-05-22","2025-08-01","2023-01-24","2025-09-04","2025-09-04","2025-09-04","2023-09-14","2023-01-24","2023-01-24","2024-03-21","2024-01-16","2023-02-09","2023-02-09","2024-01-23","2023-11-08","2023-10-12","2023-10-13","2024-06-14","2023-01-24","2023-01-07","2023-01-07","2023-01-07","2023-09-14","2024-06-14","2024-06-14","2025-07-25","2023-02-10","2023-02-10","2023-01-07","2023-07-24","2023-02-24","2023-01-13","2023-07-20","2023-03-06","2022-11-08","2022-11-17","2022-11-17","2022-11-04","2022-11-04","2022-10-17","2022-10-12","2022-10-12","2022-08-19","2022-07-19","2022-07-15","2022-07-15","2022-07-04","2022-07-04","2022-07-06","2022-07-06","2022-07-04","2022-07-04","2022-07-04","2022-07-04","2022-07-04"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BUPRENORPHINE","","","Select","Select",""],["","","BUPRENORPHINE HCL","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","LEVOFLOXACIN","","","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":{"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":[]}},{"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":""}]}]}