{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M Thibault Pelletier","gend":1,"currentgend":"","add":"42 LEDGEMERE RD","city":"ORRS ISLAND","state":"ME","zip":"04066","dob":"1940-12-16","age":"","mstatus":"","insh":"00008097800","cliId":"","pno":2078335560,"cno":2078335560,"email":"irene@glamourpools.com","ename":"","eno":"","pphy":"SHEPHERD, AMBER","ppno":2077984400,"pcpadd":"Sheepscot Valley Health Center,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2077846538,"add2":"","add3":"","madd1":"42 LEDGEMERE RD","madd2":"","madd3":"","mcity":"ORRS ISLAND","mstate":"ME","mzip":"04066","pcpfaxno":"","pcpnpi":1477941425,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8FX7JJ4WA37","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":["D485","R42","M170","Z98890","L570","L814","L821","E782","L820","L538","Z789","L298","H0014","K3189","E0590","I10","Z09","G4733","M1711","M1712","Z96651","R140","R1310","S46912A","F418","E669","G8918","R1319","I440","W19XXXD","R0789","R9089","H539","R29818","N390","E0789","H16223","I3481","I700","R141","Z6831","A000","H3412","D649","K9289","R300","K760","N281","R1011","R110","D3131","Z0101","H18421","E785","F419","E041","Z961","H179","I5030","L910","R4702","M25562","I4719","C44622","C44519","Z13220","M25561","M25521","K8689","M25461","E0520","Z79899","K529","M8588","G4710","R0683","Z23","L989","D1801","Z043","R350","Z471","M4800","I6523","M26649","R1031","I639","K869","R531","R9389","R202","K219","I4710","S50819A","W07XXXA","K5730","R198","R002","I6782","H7091","R5383","R946","W19XXXA","Z13820","R739","Z0110","R6889","H903"],"date":["2023-11-17","2025-05-28","2023-06-17","2023-08-08","2025-11-10","2025-03-17","2025-03-17","2025-10-31","2024-08-29","2024-08-29","2024-08-29","2024-08-29","2025-04-03","2023-12-07","2025-07-25","2025-10-31","2024-11-06","2023-10-03","2023-08-08","2023-01-06","2024-12-20","2024-05-10","2024-11-25","2023-04-07","2023-08-08","2024-08-14","2023-08-08","2024-11-25","2025-02-20","2025-02-19","2025-02-07","2025-05-21","2025-10-11","2025-10-11","2025-04-22","2024-04-01","2024-10-21","2025-10-12","2025-10-12","2024-11-15","2023-10-03","2023-08-10","2025-11-05","2025-07-25","2024-07-05","2025-02-21","2025-08-05","2025-06-24","2024-05-10","2025-01-27","2024-10-21","2024-10-21","2024-10-21","2025-07-25","2024-08-14","2024-04-01","2025-10-13","2025-10-13","2025-10-31","2024-05-16","2024-11-25","2025-11-17","2025-03-14","2023-12-20","2023-12-20","2024-12-03","2024-12-03","2024-12-03","2025-08-05","2024-12-03","2024-03-07","2024-05-31","2025-06-24","2025-02-16","2023-05-19","2023-05-19","2023-07-14","2023-12-20","2025-03-17","2025-01-27","2025-06-24","2023-08-10","2025-01-27","2025-10-11","2025-10-11","2025-06-24","2025-10-11","2024-07-05","2025-04-25","2024-12-27","2024-01-26","2025-03-21","2025-02-20","2024-06-28","2024-06-28","2025-06-24","2024-04-03","2025-05-21","2025-05-21","2025-05-21","2025-11-05","2023-07-11","2024-12-03","2025-02-14","2023-07-11","2022-11-18","2022-10-05","2022-08-29"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OLMESARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PRALUENT PEN","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","VALACYCLOVIR","","","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":""}]}]}