{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wayne R Putnam","gend":0,"currentgend":"","add":"420 RIDGE ROAD","city":"PERU","state":"ME","zip":"04290","dob":"1953-03-16","age":"","mstatus":"","insh":"00008732200","cliId":"","pno":2075628831,"cno":"","email":"declined@021325.com","ename":"","eno":"","pphy":"DELUCA, THOMAS J","ppno":2073647831,"pcpadd":"431 FRANKLIN ST,","pcpcity":"RUMFORD","pcpstate":"ME","pcpzip":"42762100","pcpcounty":"","pcpid":"","pcpname":"ELSEMORE DIXFIELD FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2075628831,"add2":"","add3":"","madd1":"420 RIDGE ROAD","madd2":"","madd3":"","mcity":"PERU","mstate":"ME","mzip":"04290","pcpfaxno":2073699467,"pcpnpi":1154326387,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3DE7QU0EW39","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K2950","R079","M47812","I119","I25119","M159","G5601","Z4789","K219","M75101","I2510","M47816","K5730","Z96641","R197","R195","Z0000","M25511","G4733","J310","H40053","Z0101","H5211","I10","K2289","Z96611","M19011","H40023","E039","Z471","E7800","M5451","R1011","Z09","I493","R0902","Z789","G4700","G2581","M75111","M25411","H11042","H11152","R251","G5611","M25519","G5610","J342","J343","G250"],"date":["2023-04-27","2024-04-11","2025-04-29","2024-04-26","2024-04-26","2024-04-26","2025-03-25","2024-12-27","2023-12-11","2024-11-15","2025-07-10","2025-05-13","2023-10-04","2023-10-04","2024-05-16","2023-10-02","2025-04-28","2025-03-03","2025-10-20","2023-03-17","2024-09-23","2025-09-24","2025-09-24","2025-07-30","2023-12-11","2025-02-14","2024-11-15","2025-10-20","2025-07-31","2024-11-15","2024-03-19","2023-02-24","2023-07-06","2024-08-12","2025-10-20","2025-10-20","2025-03-28","2025-03-28","2025-03-28","2024-07-27","2024-07-27","2025-04-09","2025-04-09","2024-02-19","2025-03-05","2024-11-01","2025-03-05","2022-11-30","2022-11-30","2025-10-23"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","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":""}]}]}