{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Herbert F White","gend":0,"currentgend":"","add":"481 UNITY RD","city":"Albion","state":"ME","zip":"04910","dob":"1945-01-11","age":"","mstatus":"","insh":"00008431300","cliId":"","pno":2074377009,"cno":"","email":"Hwhite1945@yahoo.com","ename":"","eno":"","pphy":"STRICKLAND, DONALD J","ppno":2076238434,"pcpadd":"\tKennebec Internal Medicine,9 Glenridge Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"KENNEBEC INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2074377009,"add2":"","add3":"","madd1":"481 UNITY RD","madd2":"","madd3":"","mcity":"Albion","mstate":"ME","mzip":"04910","pcpfaxno":2076214370,"pcpnpi":1861431819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6U59QC5HK52","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R058","H9313","K4091","H02401","H02831","H02834","H02402","H02132","R42","H04123","H16143","R5383","I480","N401","Z0000","I10","E785","Z125","H31091","K4090","N400","G319","H02403","Z0100","I4811","I4430","H903","H524","G510","M26602","Z20822","H02135","I4891"],"date":["2022-12-01","2025-09-24","2025-11-07","2023-10-17","2024-03-18","2024-03-18","2023-10-17","2024-03-18","2025-07-02","2025-11-03","2025-11-03","2025-06-17","2025-06-17","2025-06-17","2025-06-17","2023-06-08","2025-06-17","2024-06-12","2025-08-19","2025-09-17","2024-12-09","2024-11-25","2024-03-18","2024-06-27","2023-06-08","2023-06-08","2025-09-04","2022-12-19","2022-12-19","2022-12-01","2022-12-01","2024-03-18","2025-11-07"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}