{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna L Gray","gend":1,"currentgend":"","add":"17 A WINDJAMMER WAY","city":"Bath","state":"ME","zip":"04530","dob":"1956-02-29","age":"","mstatus":"","insh":"10000096661","cliId":"","pno":2073865346,"cno":2074812400,"email":"donnag099@gmail.com","ename":"","eno":"","pphy":"DECK, MARCUS M","ppno":2077984400,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"17 A WINDJAMMER WAY","madd2":"","madd3":"","mcity":"Bath","mstate":"ME","mzip":"04530","pcpfaxno":2077984018,"pcpnpi":1891717872,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2YH5WJ6AH81","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J189","J440","E1165","J209","Z1231","S0990XA","W19XXXA","M654","G5602","S8011XA","I10","E785","E119","M79661","I2510","R0789","Z043","M160","K429","K5730","K769","I77811","M25532","I219","J441","J159","R918","I517","I700","R0602","F17210","Z20822","R109","J449","M1712","M25552","M25562","Z23","E669","M8580","R928","N6489","N6313"],"date":["2023-02-28","2023-02-28","2023-02-28","2023-02-28","2024-03-26","2025-01-29","2025-01-29","2023-10-03","2023-10-03","2025-01-29","2022-11-01","2022-11-01","2025-04-24","2025-01-29","2023-02-26","2022-10-11","2025-01-29","2025-01-29","2024-04-02","2024-04-02","2024-04-02","2024-04-02","2023-09-13","2023-11-20","2023-02-26","2023-02-26","2023-02-26","2023-02-26","2023-02-26","2023-02-26","2023-02-26","2023-02-26","2024-04-02","2025-01-29","2023-05-10","2023-05-10","2023-05-10","2024-11-01","2023-05-10","2024-02-28","2022-07-27","2022-07-27","2022-07-27"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LETROZOLE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRUE METRIX BLOOD GLUCOSE MTR","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","VICTOZA 2-PAK","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","PEN NEEDLE","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","VICTOZA 3-PAK","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MECLIZINE HCL","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"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":""}]}]}