{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathleen A Graham","gend":1,"currentgend":"","add":"1 CLEAVE ST APT 505","city":"OLD ORCHARD BEACH","state":"ME","zip":"04064","dob":"1958-02-05","age":"","mstatus":"","insh":"10000104628","cliId":"","pno":5085171955,"cno":"","email":"kathyg2@prodigy.net","ename":"","eno":"","pphy":"BROCKINGTON, MORGAN","ppno":2077998596,"pcpadd":"Martins Point Health Care,153 US Rte 1","pcpcity":"Scarborough","pcpstate":"ME","pcpzip":"04074","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1 CLEAVE ST APT 505","madd2":"","madd3":"","mcity":"OLD ORCHARD BEACH","mstate":"ME","mzip":"04064","pcpfaxno":2077991730,"pcpnpi":1730812033,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6HP6W14EH46","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":["M5451","M542","G44229","M810","M19041","Z1211","R42","R519","G8929","D0371","L905","D485","Z85820","Z23","D120","D125","R195","Z780","E785","E8341","Z1231","L570","L814","L821","N281","Z538","K5730","Z124","R300","N952","N94819","Z79891","Z130","I83893","I83813","L820","H00022","M5450","M8588","M50322","M47812","I6782","N3001","R6889","D2372","M5481","M9905","M9903","M9904"],"date":["2025-06-24","2025-06-24","2025-06-24","2024-09-30","2024-09-30","2024-11-08","2025-07-07","2025-07-07","2025-07-07","2024-10-07","2024-10-07","2025-10-08","2024-12-04","2025-10-21","2024-11-08","2024-11-08","2024-11-08","2025-10-21","2025-10-14","2025-10-14","2025-10-22","2025-10-08","2025-10-08","2025-10-08","2024-07-09","2024-10-21","2024-11-08","2024-10-01","2024-09-23","2025-05-12","2024-09-23","2024-10-01","2024-09-23","2025-05-21","2025-05-21","2025-05-16","2024-11-19","2023-06-07","2023-06-07","2024-12-18","2025-07-17","2025-07-17","2023-05-04","2023-11-30","2025-10-08","2024-12-13","2023-11-21","2023-11-21","2023-11-21"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","MIEBO","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","CYCLOBENZAPRINE 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":[]}},{"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":""}]}]}