{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anita J Fournier","gend":1,"currentgend":"","add":"39 MAYER RD","city":"PORTLAND","state":"ME","zip":"04102","dob":"1957-04-26","age":"","mstatus":"","insh":"10000122539","cliId":"","pno":2076154203,"cno":"","email":"Afournier503@gmail.com","ename":"","eno":"","pphy":"NANNICELLI, ANGELEA","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":"39 MAYER RD","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04102","pcpfaxno":"","pcpnpi":1366253098,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8V05GV5MX67","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S02831K","Z428","Z85828","E119","R2681","R269","C44311","S065X0D","S3993XA","S299XXA","S6991XA","S0093XA","S199XXA","S02832A","S065XAA","E1165","S0292XA","I6200","M79601","Z0001","S0990XA","S02831A","Z743","Z1231","I10","E785","F32A","E039","S065X0A","T1490XA","S0291XA","S0230XA","H532","H1131","S066X0A","H53141","W19XXXA","S0281XA"],"date":["2025-10-27","2025-04-16","2025-04-16","2025-10-23","2025-11-05","2025-11-05","2025-04-15","2025-08-31","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-09-25","2025-07-30","2025-08-11","2025-06-02","2025-01-24","2025-01-12","2025-07-30","2025-07-30","2025-09-19","2025-07-21","2025-07-21","2025-07-21","2025-01-24","2025-07-30","2025-07-30","2025-07-30","2025-08-04","2025-08-04","2025-08-04","2025-07-30","2025-07-29","2025-07-29","2025-08-05"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","IRBESARTAN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ONETOUCH VERIO REFLECT METER","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}