{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathleen A Eaton","gend":1,"currentgend":"","add":"564 MOUNTFORT RD","city":"NORTH YARMOUTH","state":"ME","zip":"04097","dob":"1956-05-02","age":"","mstatus":"","insh":"10000083830","cliId":"","pno":"2077125184","cno":"","email":"bobkatzmaggie@gmail.com","ename":"","eno":"","pphy":"FLORY, ELIZABETH","ppno":"2077984400","pcpadd":"Martins Point Health Care,331 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":"564 MOUNTFORT RD","madd2":"","madd3":"","mcity":"NORTH YARMOUTH","mstate":"ME","mzip":"04097","pcpfaxno":"2077984018","pcpnpi":"1659865970","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7VH5CP5AQ97","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":["K644","K648","M9901","M5412","R059","J449","K649","I10","E785","E538","M8580","I7140","D2272","D492","D692","L568","L400","Z0101","H3561","L578","L821","D049","K432","Z720","K439","L570","L814","T17228A","C7652","C44721","L409","M25551","C44729","M9902","M5414","L820","Z1231","M25571"],"date":["2023-06-06","2023-04-12","2024-06-28","2024-06-28","2023-05-25","2023-10-24","2023-06-06","2024-07-08","2024-07-08","2024-07-08","2023-07-05","2023-07-11","2023-07-19","2023-07-19","2023-07-19","2023-07-19","2024-05-29","2023-08-22","2023-08-22","2024-05-29","2024-05-29","2024-01-16","2023-10-24","2023-10-24","2023-10-24","2024-05-29","2024-05-29","2024-01-22","2024-01-16","2024-05-20","2024-03-06","2024-03-20","2024-05-20","2024-05-24","2024-05-24","2024-05-29","2024-07-08","2024-07-15"],"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":[["","","Mupirocin 2 % Ointment Teva","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Ointment Padagis","","","Select","Select",""],["","","Lidocaine Viscous 2 % Oral Top Sol Advagen","","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Nexletol","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Nexlizet","","","Select","Select",""],["","","Citalopram","20 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":""}]}]}