{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James O Nesbitt Iv","gend":0,"currentgend":"","add":"51 THIRD ST","city":"PRESQUE ISLE","state":"ME","zip":"04769","dob":"1944-07-21","age":"","mstatus":"","insh":"10000011605","cliId":"","pno":2072270550,"cno":"","email":"nezimaine@yahoo.com","ename":"","eno":"","pphy":"","ppno":"","pcpadd":",","pcpcity":"","pcpstate":"","pcpzip":"00000","pcpcounty":"","pcpid":"","pcpname":"","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1796","madd2":"","madd3":"","mcity":"PRESQUE ISLE","mstate":"ME","mzip":"04769","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5FP8XU1EQ52","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L570","D492","C44222","L821","D225","L578","C44629","C44622","C44722","Z85828","C44529","M5134","L858","R202","N400","L820","R0600","G8929","K4090","R6889","D2262","Z0000","Z1211","Z85820","C44729","M5124","M546","D0362","J302","E785","R0609","B351","D2362","R5383","R42","R252","R498","K219","Z808","D0461"],"date":["2025-05-02","2024-04-25","2023-11-20","2025-05-02","2024-04-25","2025-05-02","2024-04-25","2023-04-27","2023-10-26","2025-05-02","2023-10-26","2023-10-03","2024-11-08","2023-03-22","2024-03-13","2025-05-02","2025-06-12","2023-10-03","2024-03-25","2022-12-13","2022-12-09","2024-03-13","2024-04-29","2024-11-08","2024-11-08","2023-10-03","2023-10-03","2022-12-09","2025-06-12","2025-06-12","2025-06-12","2025-05-02","2022-11-03","2022-11-15","2022-11-15","2022-11-15","2025-06-10","2025-06-10","2022-10-27","2022-10-27"],"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":[["","","JUBLIA","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","TERBINAFINE 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":""}]}]}