{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marilyn A Roberge","gend":1,"currentgend":"","add":"87 CUMBERLAND LN","city":"Gorham","state":"ME","zip":"04038","dob":"1944-11-20","age":"","mstatus":"","insh":"10000020457","cliId":"","pno":"2072220195","cno":"2072220195","email":"pmroberge@msn.com","ename":"","eno":"","pphy":"SCONTRAS, JENNIFER","ppno":"","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":"87 CUMBERLAND LN","madd2":"","madd3":"","mcity":"Gorham","mstate":"ME","mzip":"04038","pcpfaxno":"2075231135","pcpnpi":"1659908101","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3E20C35FP02","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":["M85852","M8588","N3941","R159","N3281","Z0101","I471","I252","I10","I2720","Z1211","K50812","K648","K5080","K219","G3184","E785","E559","N1830","Z7901","D509","M6284","R310","R059","K449","L720","Z1231","D492","K2100","N281","K2090","K2210","K222","Z8711","K589","R4182","G8929","M5137","M47816","M4316","M5450","N201","N132","K4020","R197","N200","L97411","L89613","S91301A","L84","Q828","R600","N1832","L97412","L570","L97511","L858","L986","N1831","L821","Z85828","L728","H2511","N390","R011","M19071","Z466","H2512","A000","Z86718","Z87891","H2513","L859","B353","N184","Z23","I083","Z86711","I129","R809","L97919","K5090","Z9049","Z79899","L929","M2170","S91309A","N138","N210","Z0000"],"date":["2023-05-08","2023-05-08","2025-11-04","2024-01-04","2026-01-15","2025-10-08","2023-09-21","2026-01-06","2026-01-30","2025-04-28","2023-10-25","2023-10-25","2023-10-25","2024-10-04","2025-11-25","2023-11-21","2025-01-23","2026-01-30","2024-07-23","2025-09-08","2024-06-13","2024-01-05","2024-02-01","2024-01-19","2024-07-08","2024-08-28","2024-01-30","2024-01-17","2024-01-31","2025-04-21","2024-01-31","2024-01-31","2024-01-31","2024-04-16","2024-04-16","2024-08-20","2024-05-14","2024-05-14","2024-05-14","2024-05-14","2024-06-28","2024-08-20","2024-08-20","2024-07-08","2024-07-08","2025-05-02","2025-09-02","2026-02-24","2025-08-19","2025-07-03","2026-02-24","2026-02-03","2025-03-17","2026-03-03","2025-08-27","2025-08-04","2025-09-22","2025-05-27","2025-11-11","2025-08-27","2025-08-27","2023-03-21","2026-02-23","2024-07-23","2024-07-10","2026-01-12","2024-08-29","2026-02-09","2025-09-16","2026-01-30","2025-09-08","2025-10-22","2026-02-03","2025-10-20","2026-02-25","2025-01-28","2025-04-28","2026-03-06","2025-04-30","2024-07-25","2025-12-18","2025-11-25","2025-11-25","2025-11-25","2025-12-31","2026-02-17","2025-01-30","2024-07-10","2024-07-10","2026-02-04"],"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":[["","","MYRBETRIQ","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","MNEXSPIKE","","","Select","Select",""],["","","FAMOTIDINE","40 MG","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Micro Labs","","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","BUPROPION HCL","300 MG","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","POTASSIUM CITRATE","15 MEQ","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","LOSARTAN","50 MG","","Select","Select",""],["","","Gentamicin 0.1 % Ointment Perrigo","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","500\/125 MG","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Lupin","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","COLESTIPOL","1 GM","","Select","Select",""],["","","OXYBUTYNIN","5 MG","","Select","Select",""],["","","FLUOROURACIL","0.05","","Select","Select",""],["","","Gentamicin 0.1 % Ointment Cosette","","","Select","Select",""],["","","Fluorouracil 5 % Cream Taro","","","Select","Select",""],["","","GENTAMICIN","0.001","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","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":""}]}]}