{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard Corey","gend":0,"currentgend":"","add":"17 BRAGG RD","city":"Dedham","state":"ME","zip":"04429","dob":"1945-02-13","age":"","mstatus":"","insh":"10000017119","cliId":"","pno":2076648529,"cno":"","email":"RGCOREY@GMAIL.COM","ename":"","eno":"","pphy":"PANDEY, SANJAY P","ppno":2079073300,"pcpadd":"St Joseph Internal Medicine,900 Broadway","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 72","madd2":"","madd3":"","mcity":"Holden","mstate":"ME","mzip":"04429","pcpfaxno":2079071923,"pcpnpi":1407127475,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1YC3FX9WK88","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M4807","M5127","M51360","M47816","H61001","D485","L570","Z85828","D229","H353132","H25811","E785","M48062","Z79899","Z7982","I6523","Z8673","I639","Z743","M5416","M461","M5417","M5450","I10","I82409","R6889","M48061","R0989","I6502","D1779","R079","I444","I119","D496","L814","I6521","H9222","D0422","H02831","H02834","H26493","Z48817","H538","R7989","Z7902","G459","L905","R0789","Z0000","L858","K219","H2511","H26492","L821","R42","R29818","H2512","R531","Z09","E782","R1310","I63311","R481","K1121","K118","M5442","Z125"],"date":["2024-10-21","2024-10-21","2024-10-21","2024-10-21","2023-12-13","2025-05-23","2025-07-21","2025-05-23","2025-05-23","2025-06-10","2023-11-29","2025-07-29","2024-10-21","2023-05-03","2023-12-13","2023-12-13","2023-12-13","2023-11-24","2023-01-15","2025-07-30","2024-01-09","2024-01-09","2025-08-12","2025-08-27","2023-01-16","2023-05-24","2024-11-13","2023-10-04","2023-10-04","2023-10-04","2023-10-04","2023-10-05","2023-10-05","2023-10-05","2023-10-11","2023-10-16","2023-11-16","2023-11-30","2024-08-13","2024-08-13","2024-08-13","2023-11-30","2023-05-18","2023-10-26","2023-10-26","2023-10-26","2025-05-23","2023-06-26","2025-04-29","2024-12-04","2025-04-24","2024-05-01","2024-05-02","2022-11-21","2025-08-28","2023-01-15","2024-05-01","2023-01-15","2023-03-03","2023-03-03","2025-04-24","2023-01-26","2023-01-26","2024-04-25","2024-04-25","2024-12-11","2022-09-13"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","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":""}]}]}