{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joanne A Conman","gend":1,"currentgend":"","add":"401 CUMBERLAND AVE APT 406","city":"PORTLAND","state":"ME","zip":"04101","dob":"1950-07-15","age":"","mstatus":"","insh":"10000104088","cliId":"","pno":2078051499,"cno":"","email":"declined@03042025.com","ename":"","eno":"","pphy":"CONNOLLY, PATRICK J","ppno":2078282402,"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":"401 CUMBERLAND AVE APT 406","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04101","pcpfaxno":2078282425,"pcpnpi":1982655098,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1GC2WG3PE02","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":["R5383","H25813","H2589","R0609","S46002A","I10","H35371","Z1231","H35353","H25812","Z961","M4316","Z13228","Z130","E039","I080","I501","R262","M25519","M79672","M25569","H25811","H5703","M25512","R0602","I5189","H35341","H353131","H43813","H40003","H40023","H268","L728","E785","R010","M25572","M25571","M76822","R2689","M810","M7542","S46092D","N630","M5137","M47816","M19011","M19012","Z0101","R922","D6862","Z0001","R0789","N393","Z1159","N8189","R32","R21","M48061","M5450","H52223","M7580","L308","M25552","M19072","M19071","H2523"],"date":["2023-07-19","2025-07-14","2025-07-14","2023-11-16","2023-06-23","2025-05-12","2023-06-06","2024-05-03","2025-08-05","2025-11-19","2025-08-05","2025-11-11","2024-04-30","2024-04-30","2025-05-12","2024-04-01","2023-10-23","2024-07-03","2024-07-03","2024-07-03","2024-07-03","2025-07-14","2025-07-14","2024-08-12","2024-04-01","2023-11-16","2025-11-19","2025-11-19","2025-11-19","2024-12-17","2024-12-17","2024-12-17","2023-11-27","2025-05-12","2023-09-25","2023-07-03","2023-07-03","2023-07-03","2023-07-03","2023-09-08","2023-07-10","2023-07-10","2023-04-17","2024-07-15","2025-02-15","2023-11-07","2024-08-12","2025-08-11","2023-04-17","2023-03-13","2023-03-13","2023-03-13","2023-03-13","2023-03-13","2023-05-22","2023-05-22","2023-04-05","2025-02-15","2024-07-15","2023-03-27","2024-07-15","2023-04-10","2025-01-23","2023-07-03","2023-07-03","2024-08-12"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","NABUMETONE","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","ACETAZOLAMIDE ER","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUOCINONIDE","","","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":""}]}]}