{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald R Vaillancourt","gend":0,"currentgend":"","add":"224 MEADOW HILL RD","city":"Greene","state":"ME","zip":"04236","dob":"1945-10-28","age":"","mstatus":"","insh":"00008765900","cliId":"","pno":2079466102,"cno":2075767946,"email":"DVCOURT9@YAHOO.COM","ename":"","eno":"","pphy":"ROSS, PAMELA E","ppno":2077955700,"pcpadd":"Central Maine Internal Medicine,12 High St Ste 400","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"224 MEADOW HILL RD","madd2":"","madd3":"","mcity":"Greene","mstate":"ME","mzip":"04236","pcpfaxno":2077955727,"pcpnpi":1144200833,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9AM4N03DK66","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M4727","M1712","M48061","H40013","K862","K8689","D469","H2513","H3530","S43402A","X58XXXA","K317","B354","M5440","M79605","Z0000","R52","M5416","D649","M5117","M5450","Z043","Z01818","E119","E785","K8020","Z1211","D122","D123","M25562","M7542","W1830XA","Y93K1","D539","M51360","M47816","M4726","K869","F439","N281","Z85038","D1803","D499","R7989","H409","M21372","N400","Z9185","M4800","L989","H401122","D490","K5730","N3281","M419","M25552","H43813","D531","R790","L03115"],"date":["2025-04-24","2025-03-31","2025-04-24","2024-11-18","2025-03-19","2025-09-29","2025-05-28","2024-11-18","2024-11-18","2024-09-22","2024-09-22","2023-04-13","2023-04-24","2024-10-31","2024-10-31","2023-09-01","2025-04-07","2025-04-07","2025-09-05","2025-04-24","2025-04-14","2024-09-22","2025-05-29","2025-03-28","2025-07-21","2023-03-30","2025-07-17","2025-07-17","2025-07-17","2025-02-10","2024-10-08","2024-10-08","2024-10-08","2023-08-25","2025-03-28","2025-04-03","2025-04-14","2023-05-25","2024-11-07","2023-03-30","2025-03-28","2025-02-27","2025-03-07","2023-09-01","2023-12-02","2023-12-02","2023-12-02","2023-12-02","2025-07-22","2025-11-04","2025-05-19","2023-04-21","2025-07-17","2025-11-04","2025-04-03","2025-04-03","2022-11-03","2022-10-13","2022-10-13","2022-09-12"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":{"indx":[],"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":""}]}]}