{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane H Reid","gend":1,"currentgend":"","add":"192 MIDDLE RD UNIT 206","city":"FALMOUTH","state":"ME","zip":"04105","dob":"1958-09-24","age":"","mstatus":"","insh":"10000114752","cliId":"","pno":2076153740,"cno":"","email":"dianehreid@gmail.com","ename":"","eno":"","pphy":"LANG, KRISTEN","ppno":2078282402,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"192 MIDDLE RD UNIT 206","madd2":"","madd3":"","mcity":"FALMOUTH","mstate":"ME","mzip":"04105","pcpfaxno":2078282433,"pcpnpi":1598298697,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9J25G01TJ58","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M4134","M4135","Z0101","I83813","M25552","M25551","M7601","M7602","I671","R4182","E785","Z13228","K900","K754","R1011","R748","E039","Z1231","I83893","M65311","M1811","M25562","M25571","M7062","M4126","M419","M4804","M5124","M5127","M51370","M47817","M8580","S0182XA","S0990XA","S199XXA","M47816","M8589","Z780","E559","M25462","M7052","M1712","M7910","S0083XA","S0011XA","I8393","R200","M25561","I639","L821","D1801","L814","D225","K222","K219","K449","D48110","H169","F419","M5414","M47814","M1711","M1611","M170","R1310","M546","M47896","I83812","R5383","M62830","M4184","M7061","M160","M4185","I773"],"date":["2024-08-21","2024-08-21","2025-04-16","2025-01-10","2025-10-27","2024-11-05","2024-06-12","2025-10-27","2025-10-25","2025-11-09","2025-04-09","2024-04-06","2025-07-15","2025-06-11","2024-10-28","2025-02-17","2025-06-09","2025-09-15","2024-08-01","2025-09-11","2025-09-11","2025-08-14","2025-08-14","2025-10-27","2025-10-27","2025-09-11","2025-05-29","2025-05-29","2025-05-29","2025-05-29","2025-05-29","2025-04-09","2025-11-04","2025-11-09","2025-11-09","2025-10-23","2024-04-18","2024-04-18","2024-04-06","2024-09-25","2024-09-25","2025-08-14","2025-08-27","2025-11-04","2025-11-04","2024-08-15","2025-09-15","2024-11-05","2025-11-09","2024-06-19","2024-06-19","2024-06-19","2024-06-19","2025-07-15","2025-07-15","2025-07-15","2025-06-26","2025-06-26","2025-09-11","2025-09-11","2025-09-11","2024-11-05","2024-11-05","2025-09-15","2025-06-11","2025-04-29","2025-04-29","2024-07-29","2025-11-09","2025-07-25","2025-04-29","2024-11-21","2025-10-27","2025-05-23","2025-10-25"],"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":[["","","ONDANSETRON ODT","","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","AZATHIOPRINE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","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":""}]}]}