{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Samuel J Glover","gend":0,"currentgend":"","add":"15 EGRET COVE","city":"Saco","state":"ME","zip":"04072","dob":"1940-09-19","age":"","mstatus":"","insh":"10000038302","cliId":"","pno":"2074948077","cno":"","email":"sjglover1940@gmail.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":"2075571206","add2":"","add3":"","madd1":"15 EGRET COVE","madd2":"","madd3":"","mcity":"Saco","mstate":"ME","mzip":"04072","pcpfaxno":"2075231136","pcpnpi":"1629431622","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8V29FT5FA51","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":["L4050","G629","C9000","Z5112","I7121","I083","M899","G620","I4891","N189","N400","I5020","Z7983","J3089","R6889","R7989","B353","L570","C44329","C44219","L608","I10","Z23","M1711","Z7982","I7120","I480","I5032","D485","C44321","D2239","L578","L720","C44319","Z0101","M898X2","M898X5","M898X8","Z5111","D649","D509","M25562","R339","M1712","M25561","D0439","L821","L718","M25462","Z515","Z7901","D0421","C44320","D692","D704","K5900","N401","R338","Z87448"],"date":["2025-11-14","2023-04-05","2026-02-24","2025-12-02","2025-02-28","2023-04-19","2023-04-19","2025-07-15","2025-08-26","2023-09-12","2025-10-30","2023-05-23","2025-07-15","2023-06-20","2023-02-14","2024-05-21","2023-08-17","2026-01-06","2023-08-17","2023-08-17","2023-08-17","2025-09-22","2025-09-29","2025-11-14","2025-07-15","2024-02-26","2025-02-28","2025-02-28","2025-12-17","2024-03-18","2024-03-18","2025-12-17","2024-03-18","2024-03-18","2025-04-07","2024-04-22","2024-04-22","2024-04-22","2026-02-24","2024-06-18","2024-07-02","2025-03-18","2024-10-24","2025-11-14","2024-10-07","2025-08-05","2025-12-17","2025-08-05","2025-03-18","2023-03-28","2025-08-26","2026-01-06","2023-03-21","2024-08-06","2025-05-16","2023-02-28","2023-01-18","2023-01-18","2023-01-18"],"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":[["","","POMALYST","","","Select","Select",""],["","","PROCHLORPERAZINE","10 MG","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","MNEXSPIKE","","","Select","Select",""],["","","METHOTREXATE","2.5 MG","","Select","Select",""],["","","ACYCLOVIR","400 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","DEXAMETHASONE","4 MG","","Select","Select",""],["","","FINASTERIDE","5 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Metronidazole 0.75 % Cream Viona Pharmaceu","","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","BORTEZOMIB","3.5 MG","","Select","Select",""],["","","Ciclopirox 0.77 % Cream Glenmark","","","Select","Select",""],["","","Fluorouracil 5 % Cream Taro","","","Select","Select",""],["","","METRONIDAZOLE","0.0075","","Select","Select",""],["","","CICLOPIROX","0.0077","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","FLUOROURACIL","0.05","","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":""}]}]}