{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dora A Direnzo","gend":1,"currentgend":"","add":"357 E BRIDGE ST","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1936-03-26","age":"","mstatus":"","insh":"10000065857","cliId":"","pno":"2078544033","cno":"","email":"","ename":"","eno":"","pphy":"ZEITLIN, JAMES","ppno":"2077745816","pcpadd":"100 FODEN ROAD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062327","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"357 E BRIDGE ST","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":"2078741483","pcpnpi":"1194794859","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4NP1RW2TQ12","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1159","L602","E1169","E1121","E785","N1831","Z0001","I6523","J189","R498","R000","I4891","R059","G4762","I129","Z7901","N2581","R944","I4821","N1832","I081","Z952","I350","N2889","I440","I4710","I498","N184","R7989","D7589","C9000","D704","S199XXA","Z5112","C9002","Z5181","Z7961","I088","I517","R931","I5032","G9341","R1030","K8020","M25551","D649","R4189","R630","E860","R197","K5289","N179","R1084","R2241","S299XXA","R0602","S3991XA","S3993XA","S0003XA","R5381","R319","K5900","Z136","E611","S7002XA","Z5111","D849","K5641","R739","Z515","Z7189","E876","Z87891","E1149","R109","E1165","N281","T796XXA","G250"],"date":["2025-09-05","2025-10-08","2025-09-05","2025-01-20","2025-05-08","2023-12-12","2025-09-05","2023-10-26","2023-11-02","2023-11-02","2023-11-02","2026-02-08","2025-01-06","2023-11-21","2024-02-29","2025-05-08","2025-01-20","2024-01-24","2025-11-14","2024-03-27","2024-09-09","2024-02-29","2024-02-16","2024-02-22","2024-03-06","2024-03-06","2024-03-06","2025-09-29","2024-02-15","2024-06-25","2026-03-10","2024-06-25","2026-02-08","2026-01-13","2025-11-17","2026-03-10","2026-03-10","2026-02-09","2026-02-09","2026-02-09","2026-02-09","2026-02-14","2024-11-08","2024-11-08","2025-08-01","2025-10-20","2025-02-17","2025-04-07","2024-11-08","2024-11-08","2024-11-08","2024-09-16","2024-10-31","2025-01-06","2026-02-08","2024-09-16","2026-02-08","2026-02-08","2026-02-08","2025-06-02","2024-12-30","2024-11-15","2026-02-09","2026-01-13","2026-02-08","2025-12-15","2025-07-28","2024-11-15","2025-05-05","2025-01-13","2025-02-17","2024-11-15","2024-11-15","2025-10-08","2025-05-06","2025-05-08","2024-08-21","2026-02-09","2024-10-18"],"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":[["","","VALACYCLOVIR","500 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","LENALIDOMIDE","2.5 MG","","Select","Select",""],["","","LOSARTAN","25 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","DEXAMETHASONE","4 MG","","Select","Select",""],["","","DIGOXIN","0.125 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","FLUAD QUAD","","","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":""}]}]}