{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Denise S Shames","gend":1,"currentgend":"","add":"12 HOWARD ST","city":"PORTLAND","state":"ME","zip":"04101","dob":"1950-01-02","age":"","mstatus":"","insh":"10000050614","cliId":"","pno":"2077736580","cno":"","email":"shamesdame@gmail.com","ename":"","eno":"","pphy":"HOFFMAN, SARA M","ppno":"2077998596","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":"","add2":"","add3":"","madd1":"12 HOWARD ST","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04101","pcpfaxno":"2078287850","pcpnpi":"1073586491","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2F67JR6DR50","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":["J3489","J343","J342","D509","N1830","D631","L509","J9601","D7581","R112","R0902","R000","K2211","K922","D62","R059","K2080","K219","E039","E669","D472","K254","K264","K5730","R1110","R590","N200","R161","J8410","Z880","L503","T782XXD","S0511XA","T782XXA","I10","R7301","E785","R7989","Z23","R748","R591","L299","K449","Z881","K2210","D7589","K259","D649","H2513","Z1231","Z13820","M85852","Z780","D471","R911","M25561","Z1589","M1711","L501","M170","M23231","R262","M2011","Z1211","D122","Z860100","D123","R635","H04123","H18593","H02403","H02831","H02834","N189","K2090"],"date":["2023-04-03","2023-04-03","2023-04-03","2023-12-07","2026-02-02","2026-02-02","2023-05-19","2023-05-19","2026-02-27","2023-05-19","2023-05-16","2023-05-15","2023-05-18","2023-05-18","2023-05-18","2023-05-25","2023-10-02","2023-09-12","2026-02-27","2024-05-16","2026-02-20","2023-05-18","2023-05-18","2023-10-02","2023-05-15","2023-08-16","2023-06-21","2023-06-21","2023-06-21","2023-08-07","2023-08-29","2023-08-29","2023-10-17","2023-07-18","2025-08-18","2025-08-18","2025-08-18","2023-05-30","2023-08-17","2025-04-17","2024-02-01","2023-08-29","2023-10-02","2023-09-12","2023-09-12","2024-01-17","2023-09-12","2024-02-01","2025-10-21","2025-11-21","2023-11-20","2023-11-20","2023-11-20","2024-02-01","2024-02-01","2024-04-19","2024-02-01","2024-02-15","2026-02-13","2024-05-16","2024-04-19","2024-04-19","2024-05-16","2025-10-29","2025-10-29","2025-10-29","2025-10-29","2026-02-27","2025-10-21","2025-10-21","2026-01-19","2026-01-19","2026-01-19","2026-02-02","2024-12-09"],"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":[["","","VALACYCLOVIR","1 GM","","Select","Select",""],["","","EPINEPHRINE","0.3 MG","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","CLINDAMYCIN","300 MG","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","LEVOTHYROXINE","25 MCG","","Select","Select",""],["","","AMITRIPTYLINE","10 MG","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","MONTELUKAST","10 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","CHLORHEXIDINE","0.0012","","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":""}]}]}