{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Herbert C Tyler","gend":0,"currentgend":"","add":"132 DIRIGO RD","city":"China Village","state":"ME","zip":"04926","dob":"1946-01-13","age":"","mstatus":"","insh":"10000011194","cliId":"","pno":"","cno":"","email":"declined@10282024.com","ename":"","eno":"","pphy":"CHAMBERLAIN, DEAN E","ppno":2074379388,"pcpadd":"Lovejoy Health Center,7 School St Ste 1","pcpcity":"Albion","pcpstate":"ME","pcpzip":"04910","pcpcounty":"","pcpid":"","pcpname":"LOVEJOY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2074452086,"add2":"","add3":"","madd1":"PO BOX 6059","madd2":"","madd3":"","mcity":"China Village","mstate":"ME","mzip":"04926","pcpfaxno":2076261849,"pcpnpi":1922360411,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5WV7TQ3JA35","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","R059","R509","S2231XA","M25462","M25562","M1711","M11261","D509","D72819","A7749","K581","L989","K219","D1801","H5789","Z0389","K5900","Z86010","Z87891","K120","K0510","K089","N4829","D649","M170","S40862A","W57XXXA","L089","J189","G9340","G928","J9601","A7982","R918","J90","R0600","R5381","I517","R404","G319","Z87898","D696","Z0000","J329","M7989","L84","L602","F32A","K5730","K760","H2513","H524","R0602","R4182","Z9981","Z125","N1831","E782","I10","Z0001","I77810","Y939","B349","R0981","C44311","C44319","J338","J342","Z0100","D61818","Z1152","D72818","A6920","S70361A","I8391"],"date":["2025-08-14","2025-05-21","2025-05-21","2023-10-25","2025-07-01","2025-07-01","2025-07-01","2025-07-01","2025-03-20","2025-03-20","2023-11-20","2025-03-18","2025-08-15","2024-06-27","2024-05-30","2024-11-24","2023-11-13","2024-02-23","2024-02-23","2024-02-23","2023-08-22","2023-08-22","2023-08-22","2023-11-24","2024-02-26","2025-07-01","2025-06-06","2025-06-06","2025-06-06","2023-11-02","2023-10-31","2023-11-02","2023-11-02","2023-11-02","2023-11-01","2023-11-01","2023-11-01","2023-10-31","2023-11-03","2023-10-31","2023-10-31","2023-11-14","2023-10-31","2023-04-21","2024-08-22","2025-04-23","2023-10-11","2023-10-11","2024-01-03","2023-11-01","2023-11-01","2023-08-09","2023-08-09","2023-11-01","2023-11-01","2023-11-01","2025-08-14","2025-08-14","2025-08-14","2023-07-25","2025-07-31","2023-11-03","2023-02-27","2023-10-25","2025-05-21","2025-10-27","2025-10-27","2024-08-22","2024-08-22","2024-08-20","2023-10-25","2023-10-25","2023-11-05","2024-03-08","2022-10-12","2022-08-09"],"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",""],["","","PAXLOVID","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","IMIPRAMINE HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SODIUM FLUORIDE ENAMEL PROTECT","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","AMMONIUM LACTATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}