{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carl H Forrest","gend":0,"currentgend":"","add":"209 DODLIN ROAD","city":"WEST ENFIELD","state":"ME","zip":"04493","dob":"1937-05-01","age":"","mstatus":"","insh":"10000009091","cliId":"","pno":2077323969,"cno":"","email":"","ename":"","eno":"","pphy":"PROKOPOVA, KATARINA","ppno":2078276605,"pcpadd":"PO BOX 1599,","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"HELEN HUNT HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"209 DODLIN ROAD","madd2":"","madd3":"","mcity":"WEST ENFIELD","mstate":"ME","mzip":"04493","pcpfaxno":2079470435,"pcpnpi":1366479875,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XP0HN3EF34","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C9110","L570","L814","L821","L728","B351","Z7983","R6889","E1151","I2510","Z85828","L820","R208","L538","G459","Z79899","Z1211","D122","D123","K635","D225","Z7189","D485","Z8673","C44319","U071","E119","M25551","E1140","C44622","R059","R21","S51811A","M109","D72829","Z86010","L2084","Z08","D045","H6123","D1801","H6092","H02055","Z0101","H40013","R053","C8591","R5383","L0390","E782","C8300","C8301","R058","J0190","C44229","M8589","C499","L299","S51801A","C8590","I10","L298","M8580","E039","I6523","M5450","E875","C8304","D479","L03114","Z6379"],"date":["2025-08-21","2025-10-20","2025-10-20","2025-10-20","2023-02-27","2025-08-18","2024-03-20","2025-08-21","2025-02-12","2023-10-30","2023-02-27","2024-02-26","2024-02-26","2024-02-26","2025-02-18","2025-03-05","2024-05-29","2024-05-29","2024-05-29","2024-05-29","2025-04-17","2025-10-20","2025-04-17","2025-06-16","2024-11-04","2024-09-17","2025-10-27","2023-05-25","2025-11-04","2023-11-16","2025-08-21","2025-08-21","2023-06-20","2025-10-27","2025-11-10","2024-05-29","2023-02-27","2023-08-28","2023-09-21","2023-03-09","2025-10-20","2023-12-07","2024-08-28","2025-09-04","2025-09-04","2025-01-16","2023-05-02","2023-05-02","2025-11-11","2025-05-15","2023-02-01","2023-06-05","2023-09-06","2023-05-18","2025-06-16","2024-03-20","2025-06-06","2025-08-21","2023-06-08","2024-06-11","2024-06-11","2024-02-26","2024-08-12","2025-11-10","2025-03-21","2024-03-19","2025-11-10","2023-06-05","2023-05-24","2022-10-06","2022-08-24"],"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":[["","","METFORMIN HCL","","","Select","Select",""],["","","CALQUENCE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ACETIC ACID","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","FLOVENT HFA","","","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":""}]}]}