{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eugene A Ross","gend":0,"currentgend":"","add":"50 FOXCROFT COURT RD","city":"Houlton","state":"ME","zip":"04730","dob":"1935-10-05","age":"","mstatus":"","insh":"00008390500","cliId":"","pno":2076940828,"cno":"","email":"","ename":"","eno":"","pphy":"THOMAS, CHRISTINE L","ppno":2075322234,"pcpadd":"PO BOX 40,","pcpcity":"CARIBOU","pcpstate":"ME","pcpzip":"47360040","pcpcounty":"","pcpid":"","pcpname":"SIGRID E TOMPKINS HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2076940828,"add2":"","add3":"","madd1":"PO BOX 643","madd2":"","madd3":"","mcity":"Houlton","mstate":"ME","mzip":"04730","pcpfaxno":2074983947,"pcpnpi":1235107848,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8T84NJ9EA67","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23","E871","H2511","Z9842","G500","H2512","H2513","Z01818","Z0000","R079","Z743","H25812","H25811","H35349","I2510","H524","Z0101","J189","I2119","H35343","H43813","K4031","S0181XA","R112","I213","Z9989","I459","I455","J449","N400","I441","D649","Z79899","E222","Z09","N390","Z98890","E870","I10"],"date":["2023-10-19","2025-07-12","2024-03-13","2024-03-07","2025-08-20","2024-02-28","2024-02-21","2023-11-21","2025-08-18","2024-05-11","2024-05-11","2024-02-01","2024-02-01","2024-02-01","2024-08-15","2024-04-12","2024-04-12","2023-09-11","2024-05-22","2023-08-29","2023-08-29","2023-12-11","2024-10-29","2025-01-14","2024-05-13","2024-05-11","2024-11-25","2024-11-08","2024-04-03","2024-01-04","2024-11-18","2024-11-12","2025-06-03","2024-11-01","2025-07-16","2023-09-11","2024-01-02","2024-11-21","2022-09-21"],"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":[["","","CLOPIDOGREL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","OXCARBAZEPINE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","MOXIFLOXACIN","","","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":""}]}]}