{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martha R Quigg","gend":1,"currentgend":"","add":"75 STATE ST UNIT 417","city":"PORTLAND","state":"ME","zip":"04101","dob":"1939-04-10","age":"","mstatus":"","insh":"10000085940","cliId":"","pno":"2076139005","cno":"","email":"marthaquigg410@gmail.com","ename":"","eno":"","pphy":"ZAGER, SAMUEL","ppno":"2078282402","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":"75 STATE ST UNIT 417","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04101","pcpfaxno":"2078287850","pcpnpi":"1821383860","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5G11XP2WK28","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":["I252","I2510","I5032","I6529","S0990XA","S199XXA","M19011","S299XXA","S3991XA","S3993XA","M25511","R519","I2720","S4981XA","U071","R531","I70213","R262","B351","L84","N6311","N6315","R921","M75101","Z043","G319","G9349","G9389","M79621","M5030","M47812","R922","R0789","J449","M40209","C50411","C50911","S40011A","S0003XA","W010XXA","Y9301","Z170","J45909","I10","E785","E039","I7090","Z1159","M8580","R2681","M6281","S0990XD","R220","G40109","W19XXXA","L851","I7091","M79671","M79672","Z79891","R296","R292","M4802","M4312","G959","G8929","L578","L814","L821","Z85828","N6459","Z08","S2231XA","J9811","S2241XA","S4991XA","R410","N390","Z8669","R2241","S60222A","S01111A","M6530","M810","C50811","G8911","S0181XA","R9089","R260","M160","S0083XA","Z853","I951","R413","F01A0","R0781","M65341","S20211A","W228XXA","R4182","R928","I4891","I110","G20C","R079","M79642","R9082","M549","R059","M25532","S0101XA","F0390","Z743","R4189","W01190A","I77819","M40204","I639","S0993XA","I69398","M5450","R2242","Z1721","Z1732","R404","S3992XA","Z483","G936","R269","R599","J1000","R32","R2689","Q6651","M47814","G8918","R1030"],"date":["2024-09-06","2025-09-05","2025-09-05","2023-04-03","2025-11-25","2024-02-06","2025-09-18","2025-05-13","2023-04-14","2023-04-14","2024-05-10","2023-04-14","2023-04-14","2023-04-14","2023-04-14","2025-12-10","2024-10-16","2025-11-21","2025-11-21","2023-08-23","2024-11-22","2023-06-26","2023-06-26","2023-07-05","2024-12-17","2025-05-13","2025-11-25","2025-05-13","2023-07-05","2023-07-05","2025-05-13","2023-07-05","2023-07-05","2025-05-13","2023-07-05","2025-01-23","2024-03-11","2026-02-12","2024-02-06","2023-07-05","2023-07-05","2025-01-23","2023-08-03","2026-02-26","2024-09-06","2025-04-17","2023-11-17","2023-08-21","2023-08-28","2025-06-17","2025-12-10","2023-10-02","2023-10-02","2023-11-27","2026-02-12","2024-10-16","2024-10-16","2024-10-16","2024-10-16","2023-11-17","2025-12-10","2023-11-27","2025-05-13","2023-12-12","2023-12-12","2023-12-22","2025-03-12","2025-03-12","2025-03-12","2025-03-12","2024-01-12","2026-02-04","2024-02-06","2024-02-06","2024-02-06","2024-05-10","2024-11-22","2024-11-22","2024-06-17","2024-09-16","2025-10-07","2025-05-13","2026-02-26","2026-02-26","2024-12-23","2024-10-12","2025-11-25","2025-10-07","2025-09-30","2025-09-30","2024-12-17","2024-11-22","2025-03-20","2025-06-30","2026-01-28","2025-10-07","2025-05-30","2026-02-12","2026-02-12","2025-04-17","2024-12-23","2025-09-05","2025-09-05","2025-06-17","2026-02-11","2024-08-21","2024-12-17","2025-11-25","2025-01-09","2024-08-21","2024-12-02","2026-02-11","2026-02-11","2025-04-15","2024-12-17","2025-05-13","2025-05-13","2025-05-14","2025-11-25","2025-11-25","2025-02-07","2024-09-16","2025-01-23","2025-01-23","2025-05-13","2024-09-09","2025-01-31","2024-11-07","2024-05-11","2024-06-17","2025-02-21","2024-11-04","2025-01-31","2025-01-31","2025-02-07","2025-01-23","2023-02-17"],"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":[["","","DULOXETINE","30 MG","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","Azelastine 0.05 % Ophth Sol Somerset","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","FELODIPINE","5 MG","","Select","Select",""],["","","Azelastine 0.05 % Ophth Sol Sandoz","","","Select","Select",""],["","","LEVOTHYROXINE","25 MCG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","TELMISARTAN","80 MG","","Select","Select",""],["","","LAMOTRIGINE","100 MG","","Select","Select",""],["","","ALENDRONATE","70 MG","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","IBUPROFEN","600 MG","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","FLUTICASONE PROP HFA","110 MCG","","Select","Select",""],["","","PFIZER-BIONTECH GRAY","","","Select","Select",""],["","","Azelastine 0.05 % Ophth Sol Apotex","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ANASTROZOLE","1 MG","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","AZELASTINE","0.0005","","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":""}]}]}