{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Breen D Libby","gend":0,"currentgend":"","add":"81 PORT RD","city":"Machiasport","state":"ME","zip":"04655","dob":"1935-11-25","age":"","mstatus":"","insh":"10000014721","cliId":"","pno":2072558589,"cno":"","email":"","ename":"","eno":"","pphy":"RIOUX, DAVID C","ppno":2072553356,"pcpadd":"11 HOSPITAL DR,","pcpcity":"MACHIAS","pcpstate":"ME","pcpzip":"46543325","pcpcounty":"","pcpid":"","pcpname":"DOWN EAST COMMUNITY HOSPITAL MEDICAL ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"81 PORT RD","madd2":"","madd3":"","mcity":"Machiasport","mstate":"ME","mzip":"04655","pcpfaxno":2072550705,"pcpnpi":1316084650,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3YN3KC0WA09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","I10","E8342","N1830","Z0001","S2232XA","Z01818","I129","Z4682","J90","J942","Z0000","S30860A","W57XXXA","M109","M25559","M6281","J358","J95811","I509","N1831","R918","M25552","E875","R0602","D649","R609","B079","W5503XA","J392","H47233","H40013","H35372","K2970","R519","S42292A","R911","R490","H6120","T148XXA","Z01812","S42302A","U071","M7989","J984","M1612","M1990","S30861A","I480","Z7901","Z23","M79605","J9811","S50811A","R55","I4820","I130","I5022","S40812A","I959","W19XXXA","E785","I429"],"date":["2025-08-20","2025-07-16","2022-11-14","2023-09-25","2024-05-21","2023-12-12","2025-04-10","2023-05-03","2024-01-20","2024-01-20","2024-01-17","2025-05-07","2024-06-18","2024-06-18","2025-03-03","2025-04-07","2024-10-04","2024-01-30","2024-01-30","2025-06-11","2025-06-11","2024-01-19","2023-10-24","2022-10-11","2022-12-29","2025-01-28","2025-04-29","2023-03-08","2025-08-20","2024-06-21","2024-08-13","2023-07-20","2023-07-20","2023-04-05","2023-04-05","2023-12-12","2023-12-12","2024-06-21","2024-02-21","2024-06-04","2024-02-22","2023-12-19","2022-12-07","2023-07-19","2024-01-16","2023-10-24","2025-07-16","2025-06-25","2022-10-11","2022-10-11","2024-10-01","2024-08-20","2024-01-19","2025-08-20","2022-09-14","2022-09-06","2022-09-06","2022-09-06","2022-09-06","2022-09-06","2022-09-06","2022-07-06","2022-06-23"],"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":[["","","SUCRALFATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SPIRONOLACTONE-HCTZ","","","Select","Select",""],["","","LISINOPRIL","","","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":""}]}]}