{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Katharine D Hardy","gend":1,"currentgend":"","add":"640 OCEAN AVE APT 220","city":"PORTLAND","state":"ME","zip":"04103","dob":"1940-11-22","age":"","mstatus":"","insh":"10000097399","cliId":"","pno":"6123883978","cno":"","email":"kdhardy40@gmail.com","ename":"","eno":"","pphy":"POULIN, SAMUEL J","ppno":"2078282402","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":"640 OCEAN AVE APT 220","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":"2078282433","pcpnpi":"1841827003","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2KY3MQ0NJ95","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":["C3411","C3490","J181","J90","Z85118","Z5189","N3281","R351","N952","R3915","E039","E785","M810","M1712","R918","R846","E041","Z923","M21062","J449","Z23","Z08","C3491","Z86718","Z7901","Z7189","Z5111","D471","R6889","Z510","H5212","H43822","J9811","J432","R600","D225","L814","L821","L578","I083","R5383","R0902","M542","G4737","R079","D45","R4189","I351","I2781","D6869","I959","G4733","I509","G4731","R0683","Z0101","H35372","R5381","I5030","L820","R208","Z130","Z85828","Z85820","L570","R0602","I5033","D492","J441","R160","K828","R110","R7989","C801","I5020","Z13228","D1801","M19031","M1811","G5601","M720","T8484XA","Z96651","Z780","R0989","M25562","S069X0A","J8489","R3129","D2339"],"date":["2026-01-07","2025-07-29","2023-04-03","2026-01-07","2024-05-16","2023-05-01","2024-06-10","2023-06-06","2024-06-10","2024-06-10","2025-11-01","2025-09-18","2025-12-05","2025-12-31","2023-08-04","2023-08-02","2025-06-02","2024-05-16","2024-10-21","2025-09-09","2025-11-12","2024-05-16","2025-11-01","2025-11-01","2023-11-10","2025-07-18","2023-12-26","2026-01-07","2024-01-02","2023-12-19","2026-02-13","2025-07-28","2024-01-16","2024-01-16","2024-02-02","2026-01-15","2026-01-15","2024-07-18","2025-07-17","2024-02-21","2025-11-12","2025-12-02","2026-01-06","2026-02-25","2026-02-18","2026-01-07","2025-04-29","2025-06-16","2026-03-07","2024-10-11","2026-02-18","2025-11-28","2025-06-16","2025-11-25","2025-09-09","2026-02-13","2026-02-13","2025-11-12","2025-07-31","2025-01-22","2025-01-22","2025-03-11","2026-01-15","2026-01-15","2025-01-22","2025-11-01","2025-03-03","2024-07-18","2025-11-01","2025-03-03","2025-03-03","2025-03-03","2025-03-03","2025-03-03","2025-06-07","2025-03-11","2024-07-18","2024-10-29","2024-10-29","2024-10-29","2024-10-29","2025-02-05","2025-02-05","2025-10-27","2024-09-19","2025-12-31","2024-09-19","2023-03-09","2023-01-18","2023-01-18"],"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":[["","","PREDNISONE","20 MG","","Select","Select",""],["","","LEVOTHYROXINE","50 MCG","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","Cyclosporine Pf 0.05 % Ophth Emuls Kvk-Tec","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","IBANDRONATE","150 MG","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","HYDROXYUREA","500 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","PROCHLORPERAZINE","10 MG","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Prasco","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","SIMVASTATIN","10 MG","","Select","Select",""],["","","MIRABEGRON","50 MG","","Select","Select",""],["","","LORAZEPAM","0.5 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","BUPROPION HCL","150 MG","","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":[]}},{"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":""}]}]}