{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cindy R Morris","gend":1,"currentgend":"","add":"149 FORT RD APT 7","city":"South Portland","state":"ME","zip":"04106","dob":"1957-08-15","age":"","mstatus":"","insh":"10000105931","cliId":"","pno":2072329573,"cno":2077712004,"email":"cinronmg@icloud.com","ename":"","eno":"","pphy":"KINGMAN, MEAGAN R","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":"149 FORT RD APT 7","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":2078282433,"pcpnpi":1477992097,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7XU4AG6JF98","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":["F319","R269","M6281","M7601","M5459","M25551","F332","M810","F3170","F411","L209","Z1231","F312","R490","F32A","M7061","M1611","R498","Z0000","F341","F1011","F323","F632","F4310","M25511","R42","D801","Z13228","Z13220","E039","Z136","L821","R0781","F315","R9089","R419","F3181","J385","J383","R410","Z1159","Z0184","M19011","R4182","F23","R531","F329","Z23","R262","G250","F419","R5383","Z87891","S20369A","W57XXXA","R6889","F418","Z0101","E079","Z79899","Z1152","M24851","L570","L02612","R238"],"date":["2025-10-28","2025-06-25","2025-06-25","2025-06-25","2025-11-19","2025-11-19","2023-10-12","2025-08-12","2025-10-01","2025-08-12","2025-01-07","2025-06-03","2024-10-17","2024-06-06","2025-06-26","2025-03-04","2025-05-29","2024-10-21","2023-03-09","2023-10-09","2023-10-09","2024-04-03","2024-04-03","2024-04-03","2025-11-12","2025-04-10","2024-02-28","2025-09-12","2025-09-12","2025-09-12","2024-03-12","2024-05-31","2023-10-23","2023-10-20","2024-02-28","2024-02-28","2024-05-09","2024-10-21","2023-10-20","2023-10-20","2024-03-12","2024-03-12","2025-11-12","2023-11-27","2023-11-27","2025-06-22","2023-10-20","2025-09-16","2025-06-22","2025-09-09","2025-09-09","2025-06-22","2025-06-22","2023-04-26","2023-04-26","2023-06-21","2023-08-30","2024-02-06","2023-10-15","2023-10-15","2023-10-15","2025-03-19","2024-06-05","2024-06-05","2024-06-05"],"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":[["","","RISPERIDONE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","EVENITY (2 SYRINGES)","","","Select","Select",""],["","","DUPIXENT PEN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ALCLOMETASONE DIPROPIONATE","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","PROLIA","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","LIOTHYRONINE SODIUM","","","Select","Select",""],["","","FLURBIPROFEN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUBLOK TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","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":""}]}]}