{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald E Ranks","gend":0,"currentgend":"","add":"47 WILLIAMS RD","city":"Chelsea","state":"ME","zip":"04330","dob":"1945-07-17","age":"","mstatus":"","insh":"10000016583","cliId":"","pno":2077130044,"cno":2073120690,"email":"DONRANKS@GMAIL.COM","ename":"","eno":"","pphy":"REATIRAZA, JOCELIN N","ppno":2074652181,"pcpadd":"Oakland Family Medicine,25 First Park Dr","pcpcity":"Oakland","pcpstate":"ME","pcpzip":"04963","pcpcounty":"","pcpid":"","pcpname":"OAKLAND FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"47 WILLIAMS RD","madd2":"","madd3":"","mcity":"Chelsea","mstate":"ME","mzip":"04330","pcpfaxno":"","pcpnpi":1598777930,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3GJ1RX3XE99","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1283","N200","N320","Z1212","Z1211","S2231XA","K56600","Z96641","K56609","H4720","E119","H409","H2513","H04123","N10","N390","R531","R6889","E785","N201","K6389","R112","N210","N3289","Z87891","L409","R251","M25559","Z0001","L821","L814","N12","Z0000","Z87440","S3991XA","S3993XA","L905","R1084","I700","R935","K760","Z0101","G4700","K862","K5900","R160","I2510","K7689","N281","H47291","H527","Z7984","R42","R197","R7303"],"date":["2024-02-21","2025-01-23","2025-01-23","2024-10-12","2024-10-12","2025-08-12","2024-01-03","2023-10-07","2023-12-31","2023-04-07","2023-12-15","2023-04-07","2023-06-13","2023-04-07","2023-05-12","2023-05-11","2023-05-12","2023-05-12","2025-10-31","2023-05-25","2024-01-02","2024-01-02","2025-11-04","2025-11-04","2023-07-25","2024-02-21","2023-05-11","2023-05-11","2025-09-23","2024-02-21","2024-02-21","2023-05-17","2023-09-12","2023-05-17","2025-08-08","2025-08-08","2023-02-16","2023-12-31","2023-12-31","2024-01-01","2025-08-26","2025-09-25","2024-01-26","2025-08-26","2023-10-07","2023-05-11","2023-05-11","2023-05-11","2023-05-11","2023-06-13","2024-06-24","2022-11-28","2022-08-25","2022-08-25","2022-08-25"],"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",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","ONETOUCH VERIO REFLECT METER","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","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":""}]}]}