{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joseph J Fazekas","gend":0,"currentgend":"","add":"246 LONG POINT RD","city":"Harpswell","state":"ME","zip":"04079","dob":"1942-12-10","age":"","mstatus":"","insh":"10000015905","cliId":"","pno":2076708410,"cno":"","email":"Jfazekas1942@gmail.com","ename":"","eno":"","pphy":"SCHWINK, ANN M","ppno":2076844010,"pcpadd":"177 NORTH MAIN ST,","pcpcity":"STRONG","pcpstate":"ME","pcpzip":"04983","pcpcounty":"","pcpid":"","pcpname":"SHEEPSCOT VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 582","madd2":"","madd3":"","mcity":"Rangeley","mstate":"ME","mzip":"04970","pcpfaxno":2076843368,"pcpnpi":1164493136,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1FT8CH8NH29","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R059","E119","R0602","R9720","N401","N138","I10","S90935A","U071","Z20822","R0609","N400","R079","R6889","M65322","R0600","Z23","E782","M25511","M9907","Z87891","J9811","I2510","M2480","Z0000","M19072","Z0100","Z136","L84","Z0101","M65331","L918","M25472","Z1212","Z1211","M7989","I723","H903","B079","M65332"],"date":["2022-12-01","2025-09-18","2023-05-17","2025-10-02","2025-10-02","2025-10-02","2025-09-19","2025-05-19","2022-12-01","2022-12-01","2023-08-24","2024-07-31","2023-05-19","2023-01-10","2024-12-20","2023-12-05","2025-09-23","2025-09-19","2025-02-06","2025-02-06","2024-09-11","2023-05-18","2023-05-18","2023-12-29","2025-09-18","2025-08-01","2023-02-09","2024-09-11","2023-02-02","2025-03-10","2024-05-09","2024-07-15","2025-05-30","2023-09-21","2023-09-21","2025-05-30","2024-10-24","2024-07-31","2024-07-15","2024-05-09"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","TERAZOSIN HCL","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AFLURIA QUAD 2022-23 (3YR UP)","","","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":""}]}]}