{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ruth M Schmutz","gend":1,"currentgend":"","add":"15 CUMMINGS ST","city":"BATH","state":"ME","zip":"04530","dob":"1943-11-02","age":"","mstatus":"","insh":"10000108789","cliId":"","pno":2078418848,"cno":"","email":"chase6339@maine.rr.com","ename":"","eno":"","pphy":"WOLFE, KAYLEE","ppno":"","pcpadd":"PO BOX 727,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49030727","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 CUMMINGS ST","madd2":"","madd3":"","mcity":"BATH","mstate":"ME","mzip":"04530","pcpfaxno":"","pcpnpi":1285364489,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4Q14D04JY99","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U071","R7989","I480","I10","I5022","Z4789","H25813","K219","E785","F418","A000","H25812","I6521","R2681","R519","Z95810","I2510","I517","I77810","I252","H43813","H903","D500","M25512","E7800","M7542","M25612","R293","R7303","Z7901","H90A21","H90A32","J9600","R300","M21371","R918","I700","Z950","Z951","I5032","M4726","M48061","M5115","M47814","I6523","I672","R29818","R9089","H6121","Z1329","Z130","Z13228","N390","R32","G5602","I739","L723","Z23","M19012","I110","H25811","R4182","M810","I4819","I7121","I25119","I071","Z9849","Z0101","R0602","R059"],"date":["2024-12-05","2024-08-19","2024-10-28","2025-04-14","2025-01-13","2025-03-26","2024-10-02","2024-10-02","2025-03-14","2025-03-14","2023-09-25","2024-10-02","2024-11-25","2023-09-23","2023-09-22","2025-07-11","2024-07-17","2023-08-14","2023-08-14","2023-08-14","2023-10-30","2024-03-04","2025-04-14","2025-08-18","2025-04-14","2025-08-18","2025-08-18","2025-08-18","2025-04-14","2024-04-23","2024-01-22","2024-01-22","2024-12-30","2024-08-21","2023-12-28","2024-07-17","2024-07-17","2024-07-17","2023-09-22","2024-04-23","2023-09-22","2023-09-22","2023-09-22","2023-09-22","2024-11-25","2023-09-22","2023-09-22","2023-09-22","2023-07-27","2024-03-25","2024-03-25","2024-03-25","2025-09-15","2024-02-19","2025-03-14","2024-11-25","2025-07-16","2023-11-27","2025-04-14","2025-04-15","2024-07-24","2025-03-14","2025-04-14","2023-09-22","2023-09-23","2023-09-23","2024-10-15","2024-10-03","2025-07-14","2024-12-04","2024-12-04"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","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":""}]}]}