{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cynthia M Horton","gend":1,"currentgend":"","add":"15 PHILLIP ST","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1945-09-27","age":"","mstatus":"","insh":"10000044769","cliId":"","pno":"2078386593","cno":"","email":"chuckandcindy4580@gmail.com","ename":"","eno":"","pphy":"CONNOLLY, MARY J","ppno":"2078741489","pcpadd":"100 FODEN RD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 695","madd2":"","madd3":"","mcity":"Scarborough","mstate":"ME","mzip":"04070","pcpfaxno":"2078741483","pcpnpi":"1558535559","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1RX9XP7MU32","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43719","H2512","R109","K838","K8689","R059","Z96612","Z96611","E042","R918","I2510","M549","Z0000","E785","I7143","K8510","I69154","K8051","K8590","D649","I10","I7140","H259","I499","I471","I4720","M542","M47812","Z8673","G9389","R404","S0990XA","W010XXA","Y93K1","R2990","R0781","Z8679","I639","G319","R9082","R531","I6523","M4802","R278","I6930","M50322","M50323","M4312","M26621","Z23","Z0001","G43709","Z0100","M62838","I69354","Z87891","R509","Z98890","Z48812","E860","R5383","B6000","I739","Z1231","R590","E049","R079","R0602","R52","R42","R519","G2581","M79605","S30861A","K581","K660","Z131","R630","M25362","R251","I69398","J1189","U071","Z4659","R9401","R011","R062","R051","E878","I350","R1084","R259","I959","K5900","Z96642","Z96653","A000","J45909","K219","I6782","G43101","G8918","H53453","R197","K449","R935","Z471","R071","K760","Z96652","S51819A"],"date":["2026-01-12","2023-05-25","2025-08-09","2023-06-06","2023-06-08","2023-06-09","2023-06-09","2023-06-09","2023-06-06","2023-06-06","2025-05-15","2024-12-12","2023-06-14","2025-11-12","2025-09-23","2023-08-02","2023-06-07","2023-06-07","2023-06-06","2023-06-06","2026-02-19","2026-01-08","2023-05-03","2023-08-15","2023-08-16","2023-08-16","2023-09-22","2024-01-03","2023-12-19","2023-12-11","2023-09-22","2023-09-22","2023-09-22","2023-09-22","2023-12-11","2023-12-11","2026-02-12","2025-12-05","2023-12-11","2023-12-09","2025-07-29","2023-12-11","2023-12-12","2023-12-22","2023-12-22","2024-01-03","2024-01-03","2024-01-03","2024-02-16","2025-09-04","2025-09-04","2025-04-07","2025-07-22","2024-12-13","2024-12-13","2025-12-05","2025-05-29","2026-02-12","2025-10-04","2025-05-08","2025-05-08","2025-05-21","2025-11-04","2026-01-06","2024-12-12","2024-12-12","2025-09-24","2025-09-24","2025-06-10","2025-07-29","2025-09-23","2026-01-08","2025-11-12","2025-05-15","2025-10-17","2025-09-23","2025-11-12","2026-02-19","2025-02-13","2025-02-13","2025-02-13","2025-12-05","2025-12-05","2025-09-23","2024-12-31","2024-11-20","2024-11-29","2024-11-29","2025-08-13","2025-09-19","2025-08-13","2025-01-13","2025-09-24","2025-07-29","2024-09-09","2024-09-09","2025-10-04","2025-09-23","2025-09-23","2025-07-15","2025-07-15","2025-09-28","2025-08-15","2025-07-29","2024-09-10","2024-09-10","2025-02-13","2024-12-12","2025-09-05","2025-02-13","2023-03-09"],"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":[["","","Oxycodone Hcl","10 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","AMITRIPTYLINE","25 MG","","Select","Select",""],["","","TOPIRAMATE","50 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","ROSUVASTATIN","5 MG","","Select","Select",""],["","","AMLODIPINE","10 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","Ketorolac 0.4 % Ophth Sol Pacific","","","Select","Select",""],["","","OSELTAMIVIR","75 MG","","Select","Select",""],["","","Esomeprazole Mag","40 MG","","Select","Select",""],["","","FLUTICASONE PROP\/SALMETEROL","100\/50 MCG","","Select","Select",""],["","","LISINOPRIL","2.5 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","Cyclobenzaprine","10 MG","","Select","Select",""],["","","ATOVAQUONE","750 MG\/5","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","LORAZEPAM","0.5 MG","","Select","Select",""],["","","ROPINIROLE","1 MG","","Select","Select",""],["","","COLESTIPOL","1 GM","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","TIZANIDINE","4 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","KETOROLAC","0.004","","Select","Select",""],["","","MUPIROCIN","0.02","","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":""}]}]}