{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Helen A Lewis","gend":1,"currentgend":"","add":"56 LOUDEN RD","city":"SACO","state":"ME","zip":"04072","dob":"1949-11-29","age":"","mstatus":"","insh":"10000075990","cliId":"","pno":"2072868515","cno":"2075902166","email":"","ename":"","eno":"","pphy":"LETELLIER, TERESA","ppno":"2072831441","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":"56 LOUDEN RD","madd2":"","madd3":"","mcity":"SACO","mstate":"ME","mzip":"04072","pcpfaxno":"2075231136","pcpnpi":"1629431622","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9X81V80PP90","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":["J449","H16202","J984","H527","H35341","H04123","G4733","R0609","J440","Z1231","E041","N3001","R300","I10","E039","R739","N3000","N3941","N3281","N390","I959","R350","N3289","K8020","K5730","E8342","Z23","R519","R32","R531","N135","I110","C73","N131","N1330","E890","E079","M899","M1612","L820","L821","Z1211","Z86010","Z8719","K51918","K5900","G459","R29818","R42","R4781","I6523","R2689","I639","L570","E871","R55","R2681","M6281","R296","H903","I340","I517","J90","R1110","I739","I7091","B351","M79674","M79675","L851","E6601","F419","I498","I4710"],"date":["2025-04-24","2023-05-04","2023-04-20","2025-11-04","2024-06-27","2024-06-27","2025-12-01","2023-07-19","2025-12-01","2025-04-01","2025-08-12","2023-11-21","2025-05-20","2025-05-15","2024-11-07","2025-05-15","2024-08-28","2023-09-06","2023-09-06","2023-09-13","2023-09-13","2023-09-13","2023-09-13","2023-09-13","2024-07-03","2024-04-02","2025-05-20","2023-09-13","2023-09-13","2025-04-21","2024-09-05","2023-09-13","2026-01-14","2023-10-10","2024-05-08","2026-01-14","2023-11-08","2023-11-14","2023-11-14","2024-02-07","2024-02-07","2024-07-03","2024-07-03","2024-07-03","2024-07-03","2024-07-03","2024-08-02","2024-07-10","2025-04-24","2024-08-02","2024-07-09","2025-05-21","2024-07-17","2025-05-14","2024-11-21","2025-05-06","2025-05-21","2025-05-21","2025-04-24","2025-01-28","2024-07-10","2024-07-10","2025-04-17","2025-04-17","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2024-11-07","2025-05-20","2025-05-06","2025-05-06"],"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":[["","","GAVILYTE-C","","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","LEVOTHYROXINE","175 MCG","","Select","Select",""],["","","BUPROPION HCL","150 MG","","Select","Select",""],["","","CARVEDILOL","25 MG","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","TRAZODONE","100 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","ALPRAZOLAM","1 MG","","Select","Select",""],["","","MESALAMINE","0.375 GM","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","FESOTERODINE","4 MG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","CITALOPRAM","20 MG","","Select","Select",""],["","","HYDRALAZINE","25 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","INDAPAMIDE","1.25 MG","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","PRAVASTATIN","20 MG","","Select","Select",""],["","","LOSARTAN","100 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","ACYCLOVIR","400 MG","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","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":""}]}]}