{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra M Connolly","gend":1,"currentgend":"","add":"121 SCHOOL ST APT 218","city":"Gorham","state":"ME","zip":"04038","dob":"1950-10-08","age":"","mstatus":"","insh":"10000042804","cliId":"","pno":"2072220600","cno":"","email":"sconnolly089@gmail.com","ename":"","eno":"","pphy":"CAREY, SEAN P","ppno":"2078392559","pcpadd":"Martins Point Health Care,575 Main St","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"121 SCHOOL ST APT 218","madd2":"","madd3":"","mcity":"Gorham","mstate":"ME","mzip":"04038","pcpfaxno":"2075231135","pcpnpi":"1447328125","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4PW0Q75UX04","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","M810","I429","I4820","R0600","R55","R0902","I501","I5030","I081","R931","R0602","R0689","I5032","I4821","Z950","R899","Z45018","I420","M25572","M19072","L659","L570","I493","Z1231","Z13220","I2510","H01139","H01134","L218","I5189","M85852","I5020","J440","I4811","H01131","R059","R069","I4891","E041","I7091","B351","M79674","L602","K5521","J984","D440","J189","D649","U071","J449","J432","Z23","R918","R109","G7281","I5023","J9601","Z736","I498","I4589","N02B6","N9089","D500","R079","R0609","R911","E782","I499","H25813","I361","I517","L300","B354","E049","J90","D509","K259","K449","K922","F418","R4182","E042","K921","D7589","L308","Z872","L578","L821"],"date":["2025-01-10","2025-04-11","2024-02-14","2024-12-23","2023-06-22","2025-04-24","2025-02-24","2025-02-25","2023-06-13","2025-02-13","2025-02-13","2025-02-10","2023-06-08","2024-02-20","2026-01-30","2026-01-30","2023-06-23","2023-11-28","2023-09-05","2023-09-19","2023-09-19","2023-10-17","2024-08-19","2025-01-06","2024-02-22","2024-02-20","2024-02-14","2024-03-19","2025-05-12","2025-05-12","2025-07-07","2024-06-11","2026-03-07","2026-03-07","2025-07-03","2025-05-12","2024-10-02","2025-02-10","2025-02-10","2025-10-09","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-02-10","2025-02-15","2025-10-22","2024-12-24","2025-02-27","2025-02-27","2025-04-09","2025-02-26","2025-02-10","2025-02-22","2025-02-27","2025-03-07","2025-03-07","2025-03-07","2025-03-07","2025-01-06","2025-01-06","2025-03-14","2025-08-19","2025-04-11","2025-02-13","2025-07-07","2024-12-24","2024-12-23","2025-02-13","2025-01-10","2025-02-25","2025-02-25","2024-08-19","2024-08-19","2024-12-17","2025-02-24","2025-02-13","2025-02-13","2025-02-13","2025-02-13","2025-02-13","2025-02-13","2024-12-17","2023-03-09","2023-03-09","2023-02-07","2023-02-07","2023-02-07","2023-02-07"],"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":[["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","Dilt-Xr","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Perrigo","","","Select","Select",""],["","","LEVOFLOXACIN","500 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Encube","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","MNEXSPIKE","","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Encube","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","Fluocinonide 0.05 % Top Sol Sun Pharma","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","BUPROPION HCL","150 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Fougera","","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","MIRTAZAPINE","7.5 MG","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Accord","","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","Ketoconazole 2 % Shampoo Padagis","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","Neo\/Polymyx\/Dex 3.5\/10","","","Select","Select",""],["","","NEO\/POLYMYX\/DEX","","","Select","Select",""],["","","FLUOCINONIDE","0.0005","","Select","Select",""],["","","TACROLIMUS","0.001","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","Select","Select",""],["","","KETOCONAZOLE","0.02","","Select","Select",""],["","","PREVNAR","","","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":""}]}]}