{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert F Foley","gend":0,"currentgend":"","add":"11 AVE THREE","city":"Scarborough","state":"ME","zip":"04070","dob":"1936-05-10","age":"","mstatus":"","insh":"00007938300","cliId":"","pno":2078836408,"cno":"","email":"","ename":"","eno":"","pphy":"MUKAI, ERIC","ppno":2078833491,"pcpadd":"301 US ROUTE 1,","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40747609","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2078836408,"add2":"","add3":"","madd1":"PO BOX 203","madd2":"","madd3":"","mcity":"Scarborough","mstate":"ME","mzip":"04070","pcpfaxno":2073968632,"pcpnpi":1750310611,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4HW0FE2DK04","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I214","I110","R93429","I2510","R519","R251","R609","I4891","L03115","I872","R600","R627","L239","Z6837","R051","T148XXA","R278","F0390","M79604","M79605","R0602","K5900","R262","Z736","R2243","R531","I5032","C4401","Z85828","L259","I10","M159","A401","I509","D72829","I5033","Z6841","E669","Z0101","N281","I083","R079","D485","C44229","S60511A","L720","L821","L570","R4182","Z743","N189","I358","G9340","Z6842","R062","I493","R5383","J9601","A400","L853","D229","I082","R7881","B955","Z79899","S0990XA","S199XXA","A419","M6281","Z23","W19XXXA"],"date":["2023-11-21","2023-02-23","2023-02-23","2024-06-05","2023-11-15","2023-11-15","2023-11-15","2024-11-03","2023-11-24","2024-05-31","2024-12-03","2025-10-31","2025-10-31","2025-10-31","2025-06-26","2024-09-15","2025-07-02","2025-07-02","2023-11-16","2023-11-16","2024-11-03","2024-12-02","2024-12-02","2024-12-02","2024-11-03","2024-11-07","2024-06-05","2023-08-22","2023-04-12","2024-11-06","2024-12-31","2023-07-03","2023-11-15","2024-12-31","2024-11-03","2023-02-23","2023-02-23","2023-02-23","2023-06-30","2024-11-03","2023-11-17","2023-02-23","2024-10-02","2024-10-02","2023-02-27","2023-02-27","2023-02-27","2024-10-02","2024-11-07","2024-11-07","2025-08-18","2023-02-23","2024-06-05","2023-07-03","2023-02-22","2023-02-22","2024-06-01","2024-06-05","2024-06-01","2023-08-22","2023-08-22","2024-06-03","2024-06-03","2024-06-03","2025-04-16","2024-06-01","2024-06-01","2024-06-01","2025-04-16","2022-10-27","2022-09-04"],"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":[["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMMONIUM LACTATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CEFTRIAXONE","","","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":""}]}]}