{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth A Adams","gend":1,"currentgend":"","add":"3 CARRIAGE WAY","city":"ALFRED","state":"ME","zip":"04002","dob":"1945-10-23","age":"","mstatus":"","insh":"10000028723","cliId":"","pno":"2078496877","cno":"2073108667","email":"Ribbya@TWC.com","ename":"","eno":"","pphy":"LETELLIER, TERESA","ppno":"2072831441","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":"3 CARRIAGE WAY","madd2":"","madd3":"","mcity":"ALFRED","mstate":"ME","mzip":"04002","pcpfaxno":"2075231136","pcpnpi":"1629431622","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8KW1UP3VH21","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":["E119","K219","J449","Z09","M47816","M4186","M5450","M4316","M4726","M4180","M5459","M419","R52","B372","Z1231","M5416","Z0000","I10","E785","M4807","M5127","M5136","J4540","R079","Z7189","M5116","R200","I5189","R030","R519","Z7689","R059","R600","J188","U099","U071","J1282","Z66","J159","L930","R42","E1136","G43709","M461","M48062","G894","Z8249","M8589","R918","I6523","M48061","Z0101","H5203","H52223","H524","R55","M810","K047","C3412","J439","F951","R000","I4710","R911","R053","I771","Z87891","M51369","M5441","R4189","C3490","M5451","J383","N644","Z1331","R7301","M533","R0982","Z130","F411","Z79891","J984","J45909","J90"],"date":["2025-02-05","2025-12-09","2025-11-07","2023-07-12","2025-12-11","2023-07-31","2024-04-09","2025-11-21","2023-11-30","2023-07-31","2023-11-30","2023-08-08","2023-08-10","2023-08-21","2024-11-05","2025-02-27","2025-11-04","2025-12-08","2025-12-08","2023-11-02","2023-11-02","2023-11-02","2024-01-29","2025-06-26","2024-10-21","2024-03-20","2025-01-24","2024-03-27","2024-03-27","2024-04-01","2025-06-16","2024-04-17","2024-04-25","2024-04-25","2024-04-25","2024-04-18","2024-04-17","2024-04-17","2024-04-17","2025-06-03","2025-12-08","2024-04-03","2024-04-03","2024-06-17","2026-02-09","2025-09-10","2024-10-20","2025-06-03","2025-11-07","2025-06-17","2025-02-27","2025-06-09","2025-06-09","2025-06-09","2025-06-09","2025-01-29","2025-06-03","2026-02-06","2026-01-02","2025-07-10","2025-06-09","2023-03-27","2025-12-08","2025-08-27","2026-03-05","2025-06-17","2025-12-03","2025-05-27","2025-06-03","2025-06-03","2025-10-08","2024-09-19","2025-07-02","2024-08-05","2024-10-30","2025-03-20","2024-07-16","2026-03-05","2024-09-23","2025-05-07","2025-05-14","2024-09-13","2025-10-08","2023-02-14"],"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":[["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","NABUMETONE","750 MG","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ALBUTEROL","1.25 MG\/3","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","PREGABALIN","50 MG","","Select","Select",""],["","","OLMESARTAN","40 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","PROAIR DIGIHALER","","","Select","Select",""],["","","ONETOUCH ULTRA BLUE","","","Select","Select",""],["","","VALACYCLOVIR","1 GM","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","SIMVASTATIN","10 MG","","Select","Select",""],["","","CITALOPRAM","10 MG","","Select","Select",""],["","","ONETOUCH ULTRA","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","CELECOXIB","200 MG","","Select","Select",""],["","","ONETOUCH DELICA PLUS","","","Select","Select",""],["","","Ipratropium 0.03 % Nas Spray Advagen","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","TIZANIDINE","2 MG","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","ALBUTEROL (","0.083%) 2.5","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","SPIKEVAX","","","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":""}]}]}