{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert E Dow","gend":0,"currentgend":"","add":"1858 MATTAMISCOMTIS RD","city":"Lincoln","state":"ME","zip":"04457","dob":"1945-02-24","age":"","mstatus":"","insh":"00008474100","cliId":"","pno":2077324366,"cno":"","email":"","ename":"","eno":"","pphy":"ADAMS, KATIE M","ppno":2079737979,"pcpadd":"PO BOX 99,","pcpcity":"LINCOLN","pcpstate":"ME","pcpzip":"44570099","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2077324366,"add2":"","add3":"","madd1":"1858 MATTAMISCOMTIS RD","madd2":"","madd3":"","mcity":"Lincoln","mstate":"ME","mzip":"04457","pcpfaxno":2077948476,"pcpnpi":1154764975,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4NF7GG0PV49","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H353131","H5201","H52221","H524","H5212","H52222","S60459A","Z0101","I10","E782","M109","D649","R5383","M79601","M79602","Z0000","F419","H2512","R079","H50312","Z961","I213","R0789","Z743","H2511","I2510","H35363","H3531","I2111","H2513","S39011A","J321","R252","E875","R739","Z77090"],"date":["2024-08-15","2024-08-15","2024-08-15","2024-08-15","2024-08-15","2024-08-15","2024-03-04","2022-11-21","2025-08-15","2025-01-27","2025-01-27","2024-06-06","2024-07-25","2024-06-10","2024-06-10","2023-12-06","2025-05-02","2023-04-04","2025-07-17","2023-04-12","2023-05-15","2025-07-17","2025-07-17","2025-07-17","2023-03-21","2025-07-24","2023-04-11","2022-11-21","2025-07-17","2023-01-24","2023-01-13","2022-08-22","2022-08-15","2022-08-15","2022-08-15","2022-08-23"],"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":[["","","LOVASTATIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":""}]}]}