{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard L Trask","gend":0,"currentgend":"","add":"119 THISTLE LN","city":"Hampden","state":"ME","zip":"04444","dob":"1938-09-04","age":"","mstatus":"","insh":"10000008194","cliId":"","pno":2072758709,"cno":2073232895,"email":"declined@032522.com","ename":"","eno":"","pphy":"RANNIE, MAX L","ppno":2079073777,"pcpadd":"C\/O ST MARYS HEALTH SYSTEM-PROVIDER ENROLLMENT,PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2075486671,"add2":"","add3":"119 Thistle Ln","madd1":"119 THISTLE LN","madd2":"","madd3":"","mcity":"Hampden","mstate":"ME","mzip":"04444","pcpfaxno":2079073778,"pcpnpi":1578057675,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7FG0UE5NV29","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R5382","K5904","K8020","K5732","D126","K219","K5900","Z0100","R531","R159","K5901","G20","Z8639","E1165","K635","R933","M5450","M5136","M47817","Z739","I609","H9392","S066X4D","K5730","D122","D123","K640","D696","D649","E8342","R109","G8929","R1031","F4321","E119","M6281","I083","I2720","H6123","Z0000","M9903","M5451","G4709","R1032","M1712","R748","Z85828","S066X0A","R0789","R55","W19XXXA","I619","D229","R935","R600","I428","G20A1","I10","J00","N1830","Z20822","Y939","R1013","E875","Z0189","I493","Z01812","H353132","C44219","H9193","F5101","M533","Z23","E1169","R5383","N289","R790","M79602","Z6379","R1084","H35362","M25562","R251","E860","D485","K4090","G20B2","M9909","R1030","S299XXA","Z96641","L821","L814","R162","M51369","K828","K7689","M1710","G4700","R419","Z79899","G20B1","M461","F32A","D509","F3341","G252"],"date":["2024-09-10","2025-08-21","2023-09-09","2023-07-18","2023-10-03","2023-10-03","2023-10-03","2025-03-14","2023-02-15","2025-08-21","2023-09-09","2023-09-09","2023-09-09","2024-09-10","2023-09-26","2023-09-26","2025-03-21","2023-07-20","2025-08-15","2025-03-01","2024-05-17","2023-05-09","2024-04-04","2023-09-26","2023-09-26","2023-09-26","2023-09-26","2023-05-03","2024-04-18","2023-12-14","2023-09-05","2025-03-21","2023-08-14","2024-02-16","2025-03-21","2025-05-12","2024-04-03","2024-04-03","2025-03-18","2025-06-17","2023-10-26","2023-11-15","2023-05-09","2024-10-08","2025-07-30","2023-11-06","2024-03-21","2024-04-02","2024-04-02","2024-04-06","2024-04-02","2024-05-17","2024-03-21","2023-09-07","2025-04-03","2025-04-03","2025-07-30","2024-04-18","2022-11-16","2023-02-27","2023-02-13","2023-02-13","2023-09-11","2024-02-22","2024-12-06","2024-05-08","2025-07-30","2025-04-01","2024-04-08","2024-07-16","2024-09-10","2022-12-15","2025-01-31","2023-02-24","2023-02-24","2023-02-24","2023-02-24","2023-02-13","2022-11-29","2023-09-09","2024-02-26","2025-01-31","2023-01-10","2023-01-10","2023-09-20","2023-08-14","2024-09-10","2023-10-26","2023-10-26","2024-04-02","2025-07-30","2023-09-20","2023-09-20","2023-05-03","2025-08-15","2023-04-24","2023-04-24","2025-02-05","2025-06-24","2025-06-24","2025-06-24","2024-11-26","2024-04-02","2025-01-03","2022-09-14","2022-08-10","2022-08-10"],"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":[["","","RIVASTIGMINE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA ER","","","Select","Select",""],["","","GLIMEPIRIDE","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","LOKELMA","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","NIFEDIPINE ER","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","PRODIGY NO CODING","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","AMILORIDE HCL","","","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":""}]}]}