{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Merle D Brann","gend":0,"currentgend":"","add":"27 ALBION RD","city":"Benton","state":"ME","zip":"04901","dob":"1936-06-12","age":"","mstatus":"","insh":"00007338600","cliId":"","pno":2074537775,"cno":"","email":"","ename":"","eno":"","pphy":"GRANDY, JOHN K","ppno":"","pcpadd":"MaineGeneral Rheumatology,15 Enterprise Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"THAYER INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"27 ALBION RD","madd2":"","madd3":"","mcity":"Benton","mstate":"ME","mzip":"04901","pcpfaxno":"","pcpnpi":1932130507,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8NT8TH6VP44","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","M25851","M25852","M9901","M542","M9902","M546","H8110","R413","F01A0","R09A2","R918","F03A0","I10","Z87891","H903","Z0000","L299","Z0001","D649","E7800","G8929","J188","S20211A","I639","R942","E871","Z1152","H6122","H9313","R2681","F0390","R0789","M51360","R9082","I63512","Z8673","K4090","M47812","M4802","M4312","M438X2","X500XXA","J8410","I3139","S199XXA","M65331"],"date":["2025-08-25","2025-08-25","2025-08-25","2025-09-29","2025-09-29","2025-09-29","2025-09-29","2025-06-30","2024-05-17","2025-04-15","2024-02-29","2025-11-10","2024-04-30","2024-08-13","2024-06-25","2025-01-14","2024-12-27","2023-12-21","2022-12-20","2022-12-21","2022-12-20","2022-12-20","2025-11-10","2025-10-14","2024-07-13","2025-11-08","2025-11-08","2025-11-08","2022-12-20","2025-01-14","2025-01-14","2025-01-14","2025-10-27","2025-08-25","2024-01-06","2024-01-06","2024-01-06","2025-11-09","2025-06-30","2025-06-30","2025-06-30","2025-06-30","2025-10-14","2025-11-10","2025-11-08","2024-02-29","2022-08-24"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}