{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald Tyrol","gend":0,"currentgend":"","add":"1653 CROSS HILL RD","city":"Vassalboro","state":"ME","zip":"04989","dob":"1946-11-13","age":"","mstatus":"","insh":"10000013261","cliId":"","pno":2075571146,"cno":"","email":"dhtyrol@fairpoint.net","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":"","add2":"","add3":"","madd1":"1653 CROSS HILL RD","madd2":"","madd3":"","mcity":"Vassalboro","mstate":"ME","mzip":"04989","pcpfaxno":2076261849,"pcpnpi":1922360411,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8TA1PA9KT93","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D472","G4733","C642","N281","I480","H26492","I4891","C880","R42","Z7901","N2889","Z5111","R079","C8300","N1832","R0609","I4811","I2510","I10","E7800","Z7689","Z08","N401","R351","Z85528","I425","C649","D649","R0683","I484","Z0001","K219","E669","R4182","Z1211","D122","Z0189","E039","C20","Z23","C8800","N184","I129","E854","I43","R6889","Z1283","I517","I5189","I4819","G8918","H538","Z789","Z1159","N289","D124","K635","I5031","Z87891","Z905","H26491","D1803","R1904","K7689","I080","L570","L820","L821","L814","D225","D2271","Z48816","L851","Z0101","Z0100","N179","N1831","E782","D123","K6389","C4330","D127","K648","K5730","N400","M1712"],"date":["2025-08-08","2025-11-17","2025-08-01","2025-08-01","2025-09-26","2024-06-12","2024-04-14","2024-09-20","2024-07-16","2024-04-14","2025-08-25","2025-11-11","2024-04-14","2025-10-06","2024-12-02","2024-08-27","2024-05-06","2024-05-30","2024-08-13","2024-03-22","2025-11-12","2023-11-01","2023-11-01","2023-11-01","2025-02-24","2025-09-15","2024-10-29","2025-08-07","2025-03-18","2024-10-25","2025-08-27","2024-09-30","2024-09-30","2024-09-30","2024-09-03","2024-09-03","2025-06-16","2024-08-19","2024-10-29","2024-12-02","2025-10-06","2024-10-04","2025-07-22","2025-09-18","2025-09-15","2023-12-13","2024-03-12","2025-06-16","2025-06-16","2024-12-30","2025-01-23","2024-04-14","2024-04-14","2025-08-06","2024-12-23","2024-09-03","2024-09-03","2024-08-02","2025-02-24","2025-02-24","2024-05-29","2024-12-05","2024-12-05","2024-12-05","2024-10-25","2025-03-26","2025-03-26","2025-03-26","2025-03-26","2025-03-26","2025-03-26","2025-02-24","2023-03-08","2024-03-07","2025-03-11","2024-09-06","2023-08-23","2023-08-23","2023-03-17","2023-03-17","2024-10-14","2023-03-17","2023-03-17","2023-03-17","2024-09-06","2022-08-08"],"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":[["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}