{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janice A Walsh","gend":1,"currentgend":"","add":"109 RIDGELAND AVE UNIT 111","city":"South Portland","state":"ME","zip":"04106","dob":"1948-07-24","age":"","mstatus":"","insh":"10000047136","cliId":"","pno":"2078318139","cno":"2078318139","email":"declined@12042025.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":"109 RIDGELAND AVE UNIT 111","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":"2078741483","pcpnpi":"1558535559","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1VN4VM3VH04","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M4850XA","S22050D","S22060D","M8000XD","S22060A","M810","M8588","J449","D381","Z0001","E785","Z0000","Z23","C3431","Z08","Z85118","Z923","Z1211","H9202","L03811","J439","J8410","J9809","J441","Z0101","H40013","S22070A","M546","M25552","Z780","M8008XA","R918","R0602","R5383","Z131","M7062","E559","M549","S0086XD","W57XXXD","Z1289","R634","H401131","C3490","N1831","R053","M4854XA","C3491","R911","S22068D","M542","M2560","M6281","M62838","J984","E8352"],"date":["2025-11-01","2023-04-27","2023-04-25","2023-04-25","2025-12-10","2023-04-28","2023-04-18","2026-02-06","2025-10-22","2025-08-06","2025-08-06","2024-07-31","2024-09-16","2025-10-07","2025-10-07","2025-10-07","2025-10-07","2023-08-14","2023-10-03","2023-10-09","2025-08-29","2023-08-11","2023-08-11","2025-07-22","2025-05-19","2025-11-19","2025-12-10","2025-12-10","2025-09-16","2025-10-14","2025-10-14","2025-08-06","2025-08-06","2025-08-06","2025-08-06","2025-07-09","2025-08-06","2024-10-28","2024-10-28","2024-10-28","2025-10-22","2026-03-02","2026-01-02","2024-08-06","2024-10-28","2025-07-22","2025-11-01","2025-08-29","2025-08-29","2023-03-28","2023-03-16","2023-03-16","2023-03-16","2023-03-16","2023-02-08","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":[["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","ATORVASTATIN","20 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","IBANDRONATE","150 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","LUMIGAN","","","Select","Select",""],["","","VALACYCLOVIR","1 GM","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","Mirtazapine","7.5 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","OHTUVAYRE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","Ciproflox\/Dexameth 0.3\/0.1 % Otic Susp Dr","","","Select","Select",""],["","","ROFLUMILAST","500 MCG","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","ALBUTEROL (","0.083%) 2.5","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CIPROFLOX\/DEXAMETH","0.3\/0.1 %","","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":""}]}]}