{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cindy H Pulire","gend":1,"currentgend":"","add":"12 WARD ST","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1956-11-30","age":"","mstatus":"","insh":"10000098602","cliId":"","pno":"2073325837","cno":"","email":"cndpulire@gmail.com","ename":"","eno":"","pphy":"TOBIAS, TRISTAN D","ppno":"2077998596","pcpadd":"Martins Point Health Care,153 US Rte 1","pcpcity":"Scarborough","pcpstate":"ME","pcpzip":"04074","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 WARD ST","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":"2077991730","pcpnpi":"1003569203","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2X46CM0HF76","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":["H43813","M1711","H1045","H01025","H16223","R932","M9907","M9900","M9901","M9902","K581","R634","K8301","F8089","R61","L570","D2339","D225","L718","M9908","Z0101","H43313","M5450","R319","M25562","M6530","M65331","M65332","M65312","R3129","R8290","G3184","K769","R109","M65322","M3500","M25331","R6889","R300","M629","N952","E0590","I700","Z1231","M67441"],"date":["2023-05-08","2023-05-02","2023-05-08","2023-05-08","2023-05-08","2023-09-15","2023-12-11","2023-12-11","2023-12-11","2023-12-11","2023-10-02","2023-05-12","2023-10-02","2023-06-12","2023-11-03","2023-06-29","2023-06-29","2023-06-29","2023-06-29","2023-09-18","2023-08-09","2023-08-09","2023-09-06","2023-09-05","2023-09-05","2023-10-16","2024-04-30","2023-09-07","2023-09-07","2023-11-02","2023-11-02","2024-04-05","2023-11-03","2023-11-03","2023-12-14","2023-12-14","2023-12-14","2023-12-06","2024-04-03","2024-04-03","2024-04-03","2024-05-06","2024-05-06","2024-05-24","2024-04-30"],"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":[["","","Linzess","","","Select","Select",""],["","","Escitalopram","10 MG","","Select","Select",""],["","","Mupirocin 2 % Ointment Taro","","","Select","Select",""],["","","Triamcinolone Acet 0.5 % Ointment Perrigo","","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Levothyroxine","88 MCG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Metronidazole 0.75 % Cream Fougera","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Paxlovid","300\/100 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Clotrimazole","10 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 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":""}]}]}