{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sharon E Wilke","gend":1,"currentgend":"","add":"60 CHASE ST 1","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1957-03-08","age":"","mstatus":"","insh":"10000096515","cliId":"","pno":2074158427,"cno":"","email":"sharonwilke066@gmail.com","ename":"","eno":"","pphy":"PATTERSON, REBECCA","ppno":2078282402,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"60 CHASE ST 1","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078282433,"pcpnpi":1215497474,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8EE9FK1CH28","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":["N958","Z118","Z113","Z1151","M9908","M9905","M9903","M9904","M9906","J069","R102","M5450","M533","M79605","M5459","Z13228","S335XXA","M9909","I2510","Z136","M25552","B0239","Z0101","H353132","M9901","M9902","N898","N390","J101","Z1231","R059","N760","N762","R42","S8012XA","Y9323","Z124","B3731","H9201","H6991","S299XXA","M25512","H00022","A6000","R0781","R0600","Z8619","J1089","G9331","H00012","S81812A","S80811A","R300","D8944","L84","S81819A","K30","F4321","Z1211","B3749","Z130","Z13220","M542","M9900","N952","B9689","N9489","M79671","R519","R6889","R109","F430","S91311A","L03115","W268XXA","S91311D"],"date":["2025-09-04","2024-04-10","2025-08-26","2024-02-27","2025-11-14","2025-11-14","2025-11-14","2025-10-30","2023-03-14","2023-01-05","2023-08-24","2023-10-27","2023-10-27","2025-11-11","2023-07-27","2024-10-23","2022-11-30","2022-11-30","2023-05-11","2024-10-23","2023-10-27","2023-06-22","2025-01-09","2025-01-09","2025-10-21","2025-11-14","2023-02-06","2023-07-13","2025-03-16","2023-02-06","2025-03-16","2025-08-19","2025-09-04","2023-06-07","2025-01-28","2025-01-28","2023-02-06","2023-03-14","2024-04-25","2024-04-25","2023-03-16","2023-10-27","2023-08-11","2025-08-21","2023-03-16","2023-03-16","2024-04-10","2023-04-20","2023-04-20","2025-08-12","2024-09-20","2024-09-20","2023-07-13","2023-01-13","2023-12-06","2024-10-03","2023-05-05","2023-05-05","2023-04-12","2025-09-04","2023-01-13","2023-01-13","2022-11-21","2022-11-21","2022-11-15","2022-11-11","2022-11-11","2022-10-03","2022-10-03","2022-10-12","2022-08-10","2022-08-24","2022-08-24","2022-08-24","2022-08-09","2022-08-12"],"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":[["","","ACYCLOVIR","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","FAMCICLOVIR","","","Select","Select",""],["","","TOBRADEX","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","TERCONAZOLE","","","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":""}]}]}