{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Catherine C Martinage","gend":1,"currentgend":"","add":"36 HILLIARD ST","city":"OLD TOWN","state":"ME","zip":"04468","dob":"1949-12-16","age":"","mstatus":"","insh":"10000082814","cliId":"","pno":"2074783713","cno":"2074783713","email":"Cathym36@roadrunner.com","ename":"","eno":"","pphy":"CYR, LEANE M","ppno":"2079073300","pcpadd":"C\/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"36 HILLIARD ST","madd2":"","madd3":"","mcity":"OLD TOWN","mstate":"ME","mzip":"04468","pcpfaxno":"2077778800","pcpnpi":"1205942216","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9Y66X20UP46","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K449","Z8719","M79671","I10","M1812","M79641","M1611","F4321","R0602","H903","M2041","Z0100","E6601","G44229","Z23","Z0000","S82832A","Z1231","Z1239","M25572","M19072","M25551","I452","R918","S0990XA","W19XXXA","M25511","S82892A","R0789","G629","M79662","S8262XA","J069","M7061","M7631","M7601","R053","M19071","M7731","M21612","M79672","R52","J029","R058","R079","S0093XA","S199XXA","H9319","L918","Z09","Z96653","Z96642","Z1211","D123","Z86010","L814","L821","Z7189","M180"],"date":["2024-11-14","2024-11-14","2026-04-30","2026-04-30","2023-08-22","2023-08-22","2025-03-14","2024-11-26","2024-11-26","2026-03-31","2024-02-13","2026-05-04","2024-12-27","2024-12-27","2024-02-13","2025-11-06","2026-06-02","2026-01-20","2024-12-26","2025-11-12","2026-01-29","2024-08-29","2024-04-21","2024-04-30","2024-04-21","2024-04-21","2024-08-29","2026-07-08","2024-04-30","2024-06-05","2026-05-22","2026-05-22","2025-02-06","2024-10-22","2024-10-22","2024-10-22","2024-11-18","2026-04-30","2026-04-30","2025-06-05","2025-06-05","2025-06-05","2025-02-06","2025-02-06","2024-04-21","2024-04-21","2024-04-21","2025-06-05","2025-06-05","2024-03-28","2024-03-28","2024-03-28","2023-12-05","2023-12-05","2023-12-05","2025-11-26","2025-11-26","2025-11-26","2023-07-26"],"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":[["","","Symbicort","","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Azithromycin","250 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":{"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":""}]}]}