{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janice M Hackett","gend":1,"currentgend":"","add":"1 PINE VALLEY RD","city":"OLD ORCHARD BEACH","state":"ME","zip":"04064","dob":"1953-01-31","age":"","mstatus":"","insh":"10000089448","cliId":"","pno":"2074150940","cno":"","email":"janhackett00@gmail.com","ename":"","eno":"","pphy":"SONTI, SMITA","ppno":"2077998596","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":"1 PINE VALLEY RD","madd2":"","madd3":"","mcity":"OLD ORCHARD BEACH","mstate":"ME","mzip":"04064","pcpfaxno":"2078287850","pcpnpi":"1992904080","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5CY5PR9FP79","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":["F331","F411","F4310","M5459","S82141A","S82101A","M6281","M25661","S52124A","S52121D","S52571D","M810","M80061D","E785","Z23","Z0101","Z713","S82141D","S82142A","R7309","R1084","Z79899","N898","S59901A","S80911A","S299XXA","S3991XA","S3993XA","S52124D","Z0100","S52391A","L290","N952","M170","M25461","N83292","R5383","R262","J309","S199XXA","M5450","M5136","M47816","D485","L570","L820","L814","M542","W19XXXA","S0990XA","M25561","L821","Z1231"],"date":["2026-07-07","2026-07-07","2026-07-07","2024-02-02","2026-03-31","2026-06-25","2026-06-25","2026-06-25","2026-04-10","2026-04-10","2026-04-10","2026-03-05","2026-04-09","2025-11-07","2025-12-16","2025-01-17","2024-11-15","2026-06-05","2026-02-21","2023-12-14","2026-01-14","2026-07-13","2026-07-16","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2026-06-05","2023-10-27","2026-02-19","2026-07-16","2026-07-16","2023-08-18","2023-08-18","2026-02-20","2025-12-30","2026-03-05","2025-12-30","2023-11-21","2023-11-21","2023-11-21","2023-11-21","2024-10-01","2024-10-01","2024-10-01","2024-10-01","2026-02-19","2026-02-19","2026-02-19","2023-08-30","2024-10-01","2023-06-15"],"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":[["","","Buspirone","10 MG","","Select","Select",""],["","","Duloxetine","30 MG","","Select","Select",""],["","","Arnuity Ellipta","","","Select","Select",""],["","","Aripiprazole","2 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Bupropion Hcl","150 MG","","Select","Select",""],["","","Amitriptyline","10 MG","","Select","Select",""],["","","Lorazepam","0.5 MG","","Select","Select",""],["","","Escitalopram","20 MG","","Select","Select",""],["","","Vilazodone","20 MG","","Select","Select",""],["","","Valacyclovir","1 GM","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Mirtazapine","15 MG","","Select","Select",""],["","","Desvenlafaxine Succ","50 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Fluarix Quad 2023-2024","","","Select","Select",""],["","","Sertraline","25 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Teva","","","Select","Select",""],["","","Gabapentin","100 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Diclofenac Sod","50 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Clobetasol 0.05 % Cream Encube","","","Select","Select",""],["","","Desvenlafaxine","50 MG","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Buspirone Hcl","","","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":""}]}]}