{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tamas L Szepsy","gend":0,"currentgend":"","add":"34 BUFFEE LANDING LN","city":"LITCHFIELD","state":"ME","zip":"04350","dob":"1938-11-24","age":"","mstatus":"","insh":"00008184900","cliId":"","pno":2072159590,"cno":"","email":"","ename":"","eno":"","pphy":"SCHIFF SLATER, SCOTT D","ppno":2076260606,"pcpadd":"Hallowell Family Practice,\t9 Union St","pcpcity":"Hallowell","pcpstate":"ME","pcpzip":"04347","pcpcounty":"","pcpid":"","pcpname":"HALLOWELL FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"34 BUFFEE LANDING LN","madd2":"","madd3":"","mcity":"LITCHFIELD","mstate":"ME","mzip":"04350","pcpfaxno":2076260022,"pcpnpi":1750354957,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3XD7VN6RR54","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N1830","R600","I10","E876","Z125","E119","R7309","E785","I2510","Z8546","M7989","Z0100","Z0001","E7800","S00211A","C44519","D492","L570","Z85828","L821","Z23","Z7182","Z713","I491","H02831","H02834","H57813","H02051","I083","J449","Z87891","C44619","D045","C44612","C44719","I493","R002","M25569","N182","L820","D229","C44622","H04123","R0609","R9720","M25562","G8929","M25561","M170","I129","R0602","R5383","B356","R32","N1831","F1021","C4441"],"date":["2025-10-16","2024-12-05","2025-10-16","2025-10-16","2023-04-04","2024-11-12","2024-11-12","2025-10-16","2025-06-17","2024-05-13","2024-12-06","2024-11-06","2025-10-23","2025-06-17","2025-02-12","2025-09-17","2025-09-17","2024-09-04","2025-09-17","2024-09-04","2025-09-08","2025-10-23","2025-10-23","2025-06-30","2023-07-12","2023-07-12","2023-02-24","2023-02-24","2025-02-27","2025-07-29","2025-09-25","2025-09-17","2025-10-09","2025-09-17","2025-09-17","2025-07-21","2025-07-21","2023-04-13","2023-02-09","2023-09-27","2025-09-17","2025-10-09","2024-11-06","2025-02-05","2022-12-21","2023-06-14","2023-06-14","2023-06-14","2023-06-14","2025-09-25","2025-10-16","2023-05-22","2024-11-12","2024-11-12","2025-09-25","2023-09-28","2022-09-22"],"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",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","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":""}]}]}