{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael P Bailey","gend":0,"currentgend":"","add":"424 EAST OXFORD RD","city":"SOUTH PARIS","state":"ME","zip":"04281","dob":"1964-06-12","age":"","mstatus":"","insh":"00008314500","cliId":"","pno":2075394758,"cno":"","email":"","ename":"","eno":"","pphy":"LATKOVICH, KATARINA Z","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400 CENTRAL MAINE INTERNAL MEDICINE","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2078907224,"add2":"","add3":"","madd1":"424 EAST OXFORD RD","madd2":"","madd3":"","mcity":"SOUTH PARIS","mstate":"ME","mzip":"04281","pcpfaxno":2077955727,"pcpnpi":1902878499,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7AC8A36VY59","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R079","M170","R002","E119","G4733","L4050","M1712","N200","N400","Z1211","K635","K5730","K648","R0789","G894","Z5309","E1129","I10","Z0000","I639","M1990","R399","M25569","G8929","M179","E6601","R52","E1169","M47816","R5383","Z9884","R791","R6889","N132","N50811","Z87442","R1030","K760","G4730"],"date":["2025-08-07","2025-09-26","2025-11-10","2025-07-29","2025-10-23","2025-10-31","2025-09-26","2025-05-12","2025-05-12","2024-10-15","2024-10-15","2024-10-15","2024-10-15","2025-08-28","2025-09-29","2025-02-10","2024-05-16","2025-09-29","2023-03-13","2023-03-13","2024-09-23","2024-05-13","2025-06-26","2024-09-23","2024-09-23","2024-08-16","2024-11-25","2023-09-19","2023-09-20","2025-08-28","2023-09-11","2025-07-29","2022-10-24","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-08-08"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LEFLUNOMIDE","","","Select","Select",""],["","","HUMIRA PEN","","","Select","Select",""],["","","SIMPONI","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FREESTYLE TEST STRIPS","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","FREESTYLE LITE METER","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","METFORMIN HCL","","","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":{"indx":[["","","","",""],[""],[""],[""],[""],[""]],"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":{"indx":[],"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":""}]}]}