{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Harold W Lilly","gend":0,"currentgend":"","add":"480 VIGUE RD","city":"WHITEFIELD","state":"ME","zip":"04353","dob":"1937-02-24","age":"","mstatus":"","insh":"00008333600","cliId":"","pno":2074624754,"cno":"","email":"declined@06052024.com","ename":"","eno":"","pphy":"CHELEUITTE, RAMON E","ppno":"","pcpadd":"12 Spruce St Ste 7,","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"MANCHESTER CARE CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"480 VIGUE RD","madd2":"","madd3":"","mcity":"WHITEFIELD","mstate":"ME","mzip":"04353","pcpfaxno":2076219766,"pcpnpi":1114059672,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3C64HR6JJ62","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H25813","R55","Z043","I130","B369","L853","R296","R5381","F32A","F419","N1830","F0390","F418","Z638","R0600","Z515","R062","R2681","M170","E1136","I495","I951","Z9181","I5032","I10","E7800","E119","L03119","E1165","K219","M179","M1712","M1711","M6281","R32","R339","F4320","I2510","Z0000","M25511","W07XXXA","Y92009","R600","I5030","L0390","J9690","I3139","H25811","N400","N189","J069","J9612","J40","R739","D649","E1122","Z79899","I453","H52223","H2589","R918","L602","B351","M6282","E039","J9692","G8929","I499","Z1211","M25561","J189","M25562","I509","R234","S3991XA","S3993XA","S299XXA","J9811","S022XXA","G319","Z87891","S0990XA","M47812","M542","L299","J101","I129","N1832","Z794"],"date":["2024-11-25","2023-09-12","2025-03-07","2025-01-28","2025-08-09","2025-08-09","2025-04-14","2025-04-03","2024-10-11","2024-10-11","2024-10-03","2025-08-14","2025-02-24","2025-02-24","2023-11-27","2024-06-06","2023-11-27","2023-11-27","2025-01-07","2024-10-17","2023-08-09","2023-08-09","2023-08-08","2024-10-29","2025-08-14","2023-11-15","2025-04-11","2023-10-16","2025-05-31","2025-08-01","2023-10-16","2023-02-16","2023-04-06","2025-07-10","2024-05-10","2024-05-10","2025-02-24","2025-08-01","2023-03-06","2025-01-29","2025-01-29","2025-01-29","2023-10-02","2024-10-03","2023-09-06","2023-04-10","2023-04-10","2024-12-09","2025-08-01","2025-08-01","2025-04-08","2024-06-06","2023-02-06","2025-05-31","2024-10-03","2024-01-03","2025-10-23","2024-10-29","2024-08-14","2024-08-14","2025-10-22","2024-10-31","2024-10-31","2025-03-17","2025-05-28","2024-01-02","2024-01-02","2023-08-31","2023-03-16","2025-01-07","2025-10-23","2023-10-31","2025-10-21","2025-07-29","2025-01-29","2025-01-29","2025-01-29","2025-01-29","2025-01-29","2025-01-29","2024-01-03","2025-01-29","2025-01-29","2025-01-29","2023-10-02","2024-02-13","2024-01-03","2024-01-03","2025-05-31"],"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":[["","","GLIPIZIDE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","CALCITRIOL","","","Select","Select",""],["","","HUMALOG KWIKPEN U-100","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","INSULIN GLARGINE-YFGN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMMONIUM LACTATE","","","Select","Select",""],["","","INSULIN LISPRO KWIKPEN U-100","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","CONTOUR NEXT TEST STRIP","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","DUTASTERIDE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","LEVEMIR FLEXPEN","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","EASY TOUCH PEN NEEDLE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","LEVEMIR FLEXTOUCH","","","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":""}]}]}