{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia M Nevins","gend":1,"currentgend":"","add":"777 STEVENS AVE APT 223","city":"PORTLAND","state":"ME","zip":"04103","dob":"1942-04-15","age":"","mstatus":"","insh":"10000076825","cliId":"","pno":"2282358372","cno":"2282358372","email":"","ename":"","eno":"","pphy":"LOUIS, EMILY C","ppno":"","pcpadd":"\tMartins Point Health Care,\t331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"777 STEVENS AVE APT 223","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":"","pcpnpi":"1366170748","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5P16WQ2JW56","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":["R300","E119","Z23","I700","I7140","N390","N3946","N3281","M810","E039","E538","L602","R262","G609","M1612","M5137","M47817","M5442","N3000","M5450","Z87891","M48061","S199XXA","I7143","K5730","M549","Z1231","J069","J9811","R0781","M8088XA","S22080D","G9341","R21","N3941","I6523","G4489","I10","R110","F341","R519","I7091","B351","M79674","R0902","R1084","R0602","S22000A","F0390","R4182","G319","G9349","F331","F419","F0394","R1030","D259","Z87440","M4854XA","Z789","R3129","N10","L851","M205X9","I7121","G9389","Z743","R079","F32A"],"date":["2024-10-07","2025-09-16","2025-10-16","2025-12-18","2024-02-11","2026-01-20","2023-11-06","2025-11-17","2024-06-25","2024-09-28","2024-01-15","2025-09-24","2024-01-29","2023-10-24","2024-02-11","2024-02-11","2024-02-11","2024-03-17","2026-01-05","2025-12-18","2025-10-30","2024-02-16","2024-02-14","2025-03-17","2024-10-07","2025-12-18","2024-02-23","2024-05-24","2025-10-22","2024-06-18","2025-12-18","2026-01-20","2024-09-30","2025-10-22","2025-11-17","2024-09-28","2025-10-30","2026-01-05","2025-10-30","2025-09-25","2025-10-30","2025-09-24","2025-09-24","2025-09-24","2025-12-18","2025-10-22","2024-09-28","2026-01-05","2026-01-05","2025-03-18","2025-12-18","2025-12-18","2025-09-12","2025-09-12","2025-09-12","2024-10-07","2024-10-07","2024-10-07","2025-12-18","2026-01-20","2025-09-19","2023-03-24","2025-06-18","2025-06-18","2025-03-17","2025-03-17","2025-03-18","2025-03-17","2025-03-19"],"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":[["","","LEVOTHYROXINE","25 MCG","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Mylan","","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Alvogen","","","Select","Select",""],["","","YUVAFEM","","","Select","Select",""],["","","CEFADROXIL","500 MG","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","FLUOXETINE","40 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Macleods","","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","DONEPEZIL","10 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","ALENDRONATE","70 MG","","Select","Select",""],["","","AMLODIPINE","2.5 MG","","Select","Select",""],["","","MIRTAZAPINE","15 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","CIPROFLOXACIN","250 MG","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","BUPROPION HCL","150 MG","","Select","Select",""],["","","METHENAMINE HIP","1 GM","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Encube","","","Select","Select",""],["","","PROPRANOLOL","120 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","ESCITALOPRAM","20 MG","","Select","Select",""],["","","METFORMIN ER GASTRIC","","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","Select","Select",""],["","","ESTRADIOL","0.0001","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}