{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda J Follansbee","gend":1,"currentgend":"","add":"11 CORALBURST LN","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1949-05-04","age":"","mstatus":"","insh":"10000100046","cliId":"","pno":2077667128,"cno":2074094593,"email":"","ename":"","eno":"","pphy":"EDWARDS, STEVEN R","ppno":2077998596,"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":"11 CORALBURST LN","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":2078287850,"pcpnpi":1710177936,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8A30Y29PD34","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H25012","M810","E213","Z1231","R1031","S0990XA","M25552","H2511","R062","M8589","H35341","H35372","K5730","N281","H2512","N390","Z23","E8352","E1136","E1122","E1169","Z8632","R58","M47812","M4312","R0989","E785","I10","S93601A","M79671","N1830","N2581","I214","N1832","E876","I2510","I5189","R079","R519","R112","Z20828","I129","R002","Z0289","E559","Z0100","Z0001","H903","I701","Z1211","K635","Z86010","K219","Z0101","Z955","D122","E210","R590","E119","E041","I081","E7800","M1712","E669","M170","M19072","M19071","M160","H43813","Z96653","M542","E8351"],"date":["2024-10-30","2025-08-28","2025-08-12","2025-02-06","2024-10-25","2025-03-23","2025-03-23","2024-10-16","2024-11-13","2024-07-29","2024-08-15","2024-08-15","2024-10-25","2025-06-25","2024-10-30","2024-11-13","2024-11-13","2025-07-01","2025-06-02","2025-06-02","2025-06-02","2025-03-23","2025-03-23","2025-03-23","2025-03-23","2024-11-13","2025-07-17","2025-09-08","2023-08-23","2023-08-23","2025-06-02","2024-05-23","2023-03-13","2025-07-01","2023-03-10","2025-07-08","2023-04-20","2023-03-07","2023-03-07","2023-03-07","2023-03-07","2025-07-01","2025-06-13","2023-03-15","2024-03-26","2023-01-31","2024-05-30","2024-05-30","2025-06-25","2024-04-10","2024-04-10","2024-04-10","2024-04-10","2024-05-02","2023-07-05","2024-04-10","2025-07-17","2025-07-17","2025-07-17","2025-07-02","2025-07-08","2025-05-30","2023-11-22","2023-11-22","2023-12-07","2023-11-09","2023-12-07","2023-11-09","2024-06-17","2023-12-07","2025-09-08","2025-09-08"],"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":[["","","NITROGLYCERIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ATENOLOL-CHLORTHALIDONE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","TELMISARTAN","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","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":{"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":""}]}]}