{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dianne Fusco","gend":1,"currentgend":"","add":"67 BRADLEY ST","city":"Portland","state":"ME","zip":"04102","dob":"1942-03-17","age":"","mstatus":"","insh":"10000017671","cliId":"","pno":"2077737922","cno":"","email":"declined@09242025.com","ename":"","eno":"","pphy":"WADLAND, WILLIAM 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 - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"67 BRADLEY ST","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04102","pcpfaxno":"2078287850","pcpnpi":"1154499002","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5JW4D35TQ78","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":["E785","E049","J449","J8489","R6889","H34231","Z0101","M9390","I6523","I2720","J441","J90","I083","R490","K219","Z8701","H348312","R918","M810","M85852","A419","J189","J9601","J440","R911","J479","R9389","Z23","M19012","J45998","R0602","M7582","S46111A","J849","Z1383","M25512","R030","R059","R0902","M8580","J432","J439"],"date":["2025-05-05","2025-05-05","2026-01-30","2023-08-31","2023-10-13","2023-12-11","2025-04-09","2024-05-03","2023-12-11","2026-01-30","2026-01-08","2024-02-19","2024-03-12","2024-04-08","2024-04-08","2024-04-08","2025-04-09","2025-12-10","2024-06-24","2024-06-24","2025-07-18","2025-08-25","2025-07-19","2025-07-17","2026-01-30","2026-02-02","2023-03-20","2025-05-12","2024-08-15","2024-09-23","2025-07-17","2024-10-03","2024-09-11","2024-09-11","2024-08-09","2024-08-15","2025-07-23","2025-07-17","2025-07-17","2025-05-05","2025-12-10","2024-09-03"],"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":[["","","PREDNISONE","10 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","ALBUTEROL\/IPRATROPIUM","3\/0.5 MG\/3","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","LOSARTAN","25 MG","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","Erythromycin 0.5 % Ophth Oint B&L","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","ERYTHROMYCIN","0.005","","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":""}]}]}