{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Toni L Mark","gend":1,"currentgend":"","add":"633 HODSDON RD","city":"POWNAL","state":"ME","zip":"04069","dob":"1955-03-12","age":"","mstatus":"","insh":"10000097669","cliId":"","pno":"2073170566","cno":"","email":"toni.l.mark@gmail.com","ename":"","eno":"","pphy":"LOUIS, EMILY C","ppno":"","pcpadd":"\tMartins Point Health Care,\t331 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":"633 HODSDON RD","madd2":"","madd3":"","mcity":"POWNAL","mstate":"ME","mzip":"04069","pcpfaxno":"","pcpnpi":"1366170748","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3FK0H71TJ14","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":["H2513","Z0000","Z0001","Z23","R748","M064","M8580","R6889","Z124","H40013","R768","M8588","R7989","E559","E785","Z1231","R944","R946","R42","R2689","Z45010","I495","Z950","R55","Z79899","E782","M1612","Z8679","Z0101","H5203","D120","M25552","I10","E669","E038","S0990XA","I422","I358","S0101XA","I499","K0889","H6121"],"date":["2023-07-24","2025-02-08","2024-10-15","2023-08-18","2023-11-27","2024-11-27","2024-10-01","2023-11-04","2023-09-11","2023-09-26","2023-10-31","2024-02-20","2024-03-07","2024-02-22","2024-11-27","2025-07-03","2024-03-07","2024-05-15","2025-07-31","2025-07-31","2024-10-29","2024-10-07","2025-12-22","2024-10-04","2025-02-08","2025-11-25","2025-07-25","2024-11-27","2025-04-11","2025-04-11","2024-08-06","2025-06-04","2024-10-07","2024-10-07","2024-10-01","2024-10-03","2024-10-03","2024-10-03","2024-10-03","2024-10-04","2023-03-06","2023-03-06"],"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":[["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","MECLIZINE","25 MG","","Select","Select",""],["","","HYDROXYCHLOROQUINE","200 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":""}]}]}