{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Herbert G Sabol","gend":0,"currentgend":"","add":"434 LOWER GUINEA RD","city":"Lebanon","state":"ME","zip":"04027","dob":"1948-10-24","age":"","mstatus":"","insh":"00008545200","cliId":"","pno":2073392113,"cno":2076081645,"email":"","ename":"","eno":"","pphy":"GELLER, ALEXANDER L","ppno":6033303404,"pcpadd":"Skyhaven Internal Medicine,6 Healthcare Dr Ste 2","pcpcity":"Rochester","pcpstate":"NH","pcpzip":"03867","pcpcounty":"","pcpid":"","pcpname":"ROCHESTER PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2073392113,"add2":"","add3":"","madd1":"434 LOWER GUINEA RD","madd2":"","madd3":"","mcity":"Lebanon","mstate":"ME","mzip":"04027","pcpfaxno":6033328175,"pcpnpi":1932281243,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4X05DA4PY50","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","M7552","M25511","M25512","J101","Z1152","I10","Z886","Z888","Z91011","M722","M79671","Z23","J9811","Z0000","D225","L820","M549","K5732","K219","R1314","Z86010","M25561","M25562","M25551","M25552","H4423","H35372","M159","H43393","H532","J449","K921","M150","L570","M5450","R8290","D229","L814","L578","L821","G8929","L702","G250","D485","R350","K3189","N200","N281","Z9049","R300","R1319","Z1331","N401","H35341","R197","F419","F32A","E663"],"date":["2023-08-03","2025-10-27","2025-10-27","2025-10-27","2025-02-01","2025-02-01","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2024-02-21","2024-02-21","2023-09-18","2025-02-01","2025-01-22","2025-02-26","2025-02-26","2024-08-01","2022-12-12","2024-07-30","2023-01-11","2022-12-12","2025-10-07","2025-08-25","2025-09-08","2025-09-08","2024-03-27","2025-03-26","2024-07-30","2024-03-27","2024-03-27","2023-11-09","2024-07-17","2023-11-09","2025-02-26","2024-08-01","2024-08-01","2025-02-26","2025-02-26","2025-02-26","2025-08-13","2025-08-25","2025-08-13","2025-08-06","2025-02-26","2025-10-15","2023-01-11","2025-05-12","2025-05-12","2025-05-12","2025-10-29","2023-01-11","2025-08-06","2024-01-15","2025-03-26","2022-11-14","2022-11-14","2022-10-20","2022-10-20"],"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":[["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PRIMIDONE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FAMOTIDINE","","","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":""}]}]}