{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Franciscus Jongerden","gend":0,"currentgend":"","add":"125 HARRISBURG AVE APT 14","city":"Westbrook","state":"ME","zip":"04092","dob":"1940-12-03","age":"","mstatus":"","insh":"00007782200","cliId":"","pno":2075904116,"cno":"","email":"jjongerden@roadrunner.com","ename":"","eno":"","pphy":"MOHAN, ELIZABETH A","ppno":"","pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"125 HARRISBURG AVE APT 14","madd2":"","madd3":"","mcity":"Westbrook","mstate":"ME","mzip":"04092","pcpfaxno":"","pcpnpi":1952622151,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2Y61V88RN25","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":["F5221","N401","E785","R9720","M25562","D649","R109","R112","K625","K219","Z87891","R4182","M1712","J439","R9439","R079","L821","L299","K838","N281","R1110","R1013","M7632","Z96651","I2089","Z86010","K5730","K648","I25118","E870","R6889","I2582","R3912","Z0001","N400","Z1211","K3189","K2950","K222","K449","K0500","Z01812","Z0000","Z23","Z136","I700","Z8249","D509","Z13228"],"date":["2025-09-16","2025-09-16","2025-10-17","2022-12-30","2023-11-21","2025-07-07","2023-06-28","2023-06-28","2024-03-16","2025-05-19","2025-02-12","2025-02-12","2025-05-05","2024-06-17","2025-10-28","2025-10-03","2023-01-25","2023-01-25","2023-06-30","2023-06-30","2023-06-30","2023-06-30","2024-01-16","2024-01-16","2025-10-17","2024-05-22","2024-05-22","2024-05-22","2025-10-31","2025-07-07","2023-04-18","2025-10-31","2024-10-30","2025-04-04","2025-02-12","2024-05-22","2024-08-02","2024-08-02","2024-08-02","2024-08-02","2025-07-03","2025-01-29","2024-04-01","2025-04-04","2022-08-19","2022-08-19","2022-08-19","2022-07-08","2022-07-08"],"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":[["","","NITROGLYCERIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}