{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marie E Libby","gend":1,"currentgend":"","add":"170 WATERBORO ROAD","city":"HOLLIS CENTER","state":"ME","zip":"04042","dob":"1942-06-13","age":"","mstatus":"","insh":"10000046007","cliId":"","pno":"2074595102","cno":"","email":"MARIELIBBY@GMAIL.COM","ename":"","eno":"","pphy":"KU RUTH, PHYLLIDIA M","ppno":"2077745816","pcpadd":"100 FODEN RD W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062319","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"170 WATERBORO ROAD","madd2":"","madd3":"","mcity":"HOLLIS CENTER","mstate":"ME","mzip":"04042","pcpfaxno":"2078741483","pcpnpi":"1497724108","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1WA2VD4MK27","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","M19072","L089","L0390","I480","I2510","I509","Z89422","I890","L97522","M86672","L03032","I7091","B351","M79674","L602","E11621","I4821","I5032","Z23","S91105A","L97512","L97922","M19071","M19011","M19012","L97529","L03031","R600","S0990XA","W1789XA","S299XXA","S0101XA","R519","M542","M25512","S199XXA","Z9181","L570","D485","Z8739","I739","E871","E8352","R7989","R251","M869","I872","Z7901","M86172","I082","I4891","I5033","I130","N189","K219","E669","G4730","L97528","M810","R7309","E042","E8342","D509","I110","Z0000","S90421A","E6601","M86171","E785","Z6839","I96","M86671","H35363","Z0100","M8588","M8580","M159","M25511","R0602","R531","R2681","I083","A000","I10","I493","M2041","M86071","R2689","E668","L600","Z4789","C44622","M79641","M79642","Z0001","R55","L821","E6689","M2010","D0461","S91104A","R4182","T8189XA","S91301A","W19XXXA","E782","S91109A","K047","R29898","I4811","Z89421","Z89432","M6281","G629","R5383","M5450","M2142","M2141","M25552"],"date":["2026-02-17","2023-08-03","2023-04-13","2023-04-06","2023-07-26","2026-03-05","2023-04-06","2025-12-17","2023-10-07","2023-08-08","2023-08-03","2023-07-10","2024-12-18","2024-12-18","2024-12-18","2023-10-19","2023-07-20","2026-03-05","2026-03-05","2025-10-09","2023-05-22","2023-07-20","2023-08-03","2023-06-13","2023-10-16","2023-10-16","2023-06-13","2025-07-21","2023-07-20","2025-11-27","2023-06-26","2025-04-07","2023-06-26","2023-06-26","2023-06-26","2026-01-06","2025-11-27","2025-03-08","2023-06-14","2023-06-14","2024-06-20","2025-04-09","2025-05-22","2023-07-10","2023-07-25","2023-07-31","2023-08-04","2023-07-31","2025-05-06","2023-12-22","2023-08-03","2025-08-25","2024-05-20","2026-01-31","2023-08-02","2025-07-29","2023-08-09","2025-07-29","2023-08-09","2023-09-26","2023-09-26","2023-09-26","2023-09-26","2023-09-26","2024-12-18","2024-12-18","2023-11-14","2025-07-29","2025-07-29","2025-02-26","2023-12-22","2025-04-13","2023-12-22","2026-02-24","2026-02-24","2024-02-07","2024-02-20","2024-02-20","2026-01-06","2024-05-19","2025-04-10","2024-05-20","2024-05-20","2025-05-06","2026-03-05","2024-07-11","2025-07-03","2025-07-29","2025-11-27","2024-09-13","2026-01-30","2025-04-03","2025-12-31","2025-10-09","2025-10-09","2025-10-09","2025-11-28","2026-01-22","2025-09-15","2025-02-11","2026-01-22","2025-04-29","2025-02-26","2025-06-05","2024-07-20","2025-11-27","2024-07-31","2024-07-20","2024-07-20","2025-05-01","2025-08-26","2025-12-09","2025-12-09","2025-10-23","2025-12-09","2025-03-08","2025-11-27","2025-12-17","2025-12-17","2025-04-07"],"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":[["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","BUMETANIDE","1 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","ATORVASTATIN","20 MG","","Select","Select",""],["","","ALENDRONATE","70 MG","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","TORSEMIDE","100 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","WEGOVY","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","METOLAZONE","2.5 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","ELIQUIS","","","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":""}]}]}