{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William C Pickford","gend":0,"currentgend":"","add":"132 GOOSEPECKER RIDGE RD","city":"FREEDOM","state":"ME","zip":"04941","dob":"1947-01-22","age":"","mstatus":"","insh":"10000016730","cliId":"","pno":2075429906,"cno":2075429906,"email":"wcpickford@hotmail.com","ename":"","eno":"","pphy":"LANTZ, NATASHA L","ppno":2078588353,"pcpadd":"PO BOX 468,","pcpcity":"SKOWHEGAN","pcpstate":"ME","pcpzip":"49760468","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE AND WALK IN CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"132 GOOSEPECKER RIDGE RD","madd2":"","madd3":"","mcity":"FREEDOM","mstate":"ME","mzip":"04941","pcpfaxno":"","pcpnpi":1215459029,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5H75N66UC57","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","I25709","E782","Z951","Q2112","I080","A000","M9902","M546","M9908","M9903","I214","I350","N1831","N179","R0609","J90","R9389","M9900","M9901","G8918","I2510","E785","R011","R4182","Z0101","H04123","H11153","H0288A","Z961","N189","R0600","Z48812","I25110","Z01810","I6523","R918","R6889","L570","L821","L814","D225","L728","Z01818","R931","I352","I77810","J189","B078","L02212","L538","I491","R9439","Z8616","L720","R079","R0602","R0781","I252","Z08","L820","C44612","R208","I959","C44519","S0101XA","Z7189","D485","M542","Z125"],"date":["2025-04-22","2024-10-07","2024-10-07","2024-12-03","2024-04-26","2024-04-25","2024-05-04","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2024-07-03","2024-04-24","2024-04-24","2024-05-06","2024-01-25","2024-05-21","2024-05-07","2024-05-02","2024-05-02","2024-05-02","2024-04-24","2025-01-21","2024-04-24","2024-04-24","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-05-01","2022-11-29","2024-05-04","2025-10-23","2024-04-23","2024-04-23","2024-04-26","2023-05-30","2025-01-16","2025-01-16","2025-01-16","2025-01-16","2023-05-12","2024-04-23","2024-04-22","2024-04-23","2024-04-22","2024-05-03","2025-07-15","2023-08-07","2025-07-15","2024-04-17","2024-04-24","2024-04-24","2023-10-11","2024-04-19","2024-04-15","2025-03-31","2024-09-25","2025-01-16","2025-01-16","2024-11-06","2023-10-11","2024-04-25","2022-12-14","2024-07-09","2024-07-17","2024-07-17","2022-09-20","2022-09-01"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}