{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ralph C Lane","gend":0,"currentgend":"","add":"18 KARLAS WAY","city":"SIDNEY","state":"ME","zip":"04330","dob":"1942-11-16","age":"","mstatus":"","insh":"10000010745","cliId":"","pno":2077161379,"cno":2073145417,"email":"rlanesr1@roadrunner.com","ename":"","eno":"","pphy":"CIANFARANO, ROBERT P","ppno":2074652181,"pcpadd":"4 CLEMENT WAY,","pcpcity":"BELGRADE","pcpstate":"ME","pcpzip":"04917","pcpcounty":"","pcpid":"","pcpname":"OAKLAND FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 KARLAS WAY","madd2":"","madd3":"","mcity":"SIDNEY","mstate":"ME","mzip":"04330","pcpfaxno":2074654629,"pcpnpi":1962591271,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1HY7D46TK46","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D649","K3182","D472","G4700","R011","J449","R059","S83242A","S83282A","X58XXXA","I352","R21","I25111","I350","K264","R6889","I252","I10","D508","R079","I2510","D509","K922","M25562","M7021","Z96652","M1712","Z0001","D500","E854","Z09","I25110","I110","Z96642","Z98890","I214","K31819","F17210","R419","Z87891","R0609","J9811","E785","K219","J208","B9689","R42","C4441","L570","R41841","Z1283","R410","R0600","J439","Z743","I209","L821","Z85828","Z8719","L989","R4189","R413","K121","J029","G3184","I6381","M23222","Z0000","I6523","M1711","B351","R778","Z862","Z23","I080","Z955","K250","D62","I200","Z4802","Z0101","M170","D485","K5732","I219","N200","R109","R9082","G319","G459","M7989","F419","R2231","K921","T189XXA","Z7982"],"date":["2025-04-24","2024-11-06","2025-08-12","2024-02-23","2024-02-08","2024-12-09","2024-12-09","2025-07-23","2025-07-23","2025-07-23","2025-05-07","2024-06-21","2024-07-02","2024-07-02","2024-07-02","2023-05-24","2023-07-03","2025-11-03","2023-03-30","2024-05-10","2025-08-12","2025-11-11","2024-04-15","2025-02-11","2025-11-12","2023-03-24","2023-06-06","2025-01-03","2024-09-09","2024-02-06","2025-02-10","2024-05-10","2024-05-10","2023-06-06","2023-06-06","2023-04-11","2024-11-06","2023-04-08","2023-04-08","2025-11-12","2024-05-10","2024-05-10","2025-02-04","2024-11-06","2024-04-15","2024-04-15","2023-08-02","2025-05-22","2025-08-14","2024-08-29","2025-02-12","2024-01-10","2024-01-10","2024-01-10","2023-04-08","2024-05-11","2025-08-14","2025-08-14","2025-05-05","2025-10-15","2023-08-02","2023-11-30","2023-10-12","2023-10-12","2023-10-12","2023-04-21","2025-07-15","2023-11-30","2023-05-16","2025-07-15","2025-04-01","2024-01-11","2025-08-12","2023-11-30","2025-01-07","2024-05-10","2024-05-13","2024-05-13","2023-04-07","2025-03-20","2023-05-24","2024-06-07","2025-03-06","2024-09-16","2023-04-10","2024-09-16","2024-09-16","2023-09-24","2023-09-24","2023-09-24","2025-10-23","2024-02-23","2024-05-20","2022-08-18","2022-08-09","2022-08-26"],"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":[["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","TEMAZEPAM","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","EPINEPHRINE","","","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":""}]}]}