{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Fred C Rea","gend":0,"currentgend":"","add":"149 STACKPOLE WAY","city":"ELLSWORTH","state":"ME","zip":"04605","dob":"1946-11-20","age":"","mstatus":"","insh":"10000017244","cliId":"","pno":2076640033,"cno":2074602216,"email":"fredrea65@gmail.com","ename":"","eno":"","pphy":"HANSON, CASEY S","ppno":2076675899,"pcpadd":"PO BOX 8,","pcpcity":"BAR HARBOR","pcpstate":"ME","pcpzip":"46090008","pcpcounty":"","pcpid":"","pcpname":"TRENTON HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"149 STACKPOLE WAY","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2078015123,"pcpnpi":1164536397,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AA0D86WQ11","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","I4891","Z0100","H40013","D84821","I340","M5450","M353","Z7952","M85852","Z5181","R200","R0789","I351","I495","M25551","Z45018","Z5189","Z952","R011","R570","I9581","R001","I498","I499","Z01810","I2510","I341","N1832","D631","C880","Z79899","E039","Z955","M159","Z1211","S40861A","I77810","R9431","Z950","M5116","M4186","I442","I4819","Z98890","Z09","R931","J90","J9811","J811","J939","Z01818","Z13820","K5989","D472","M7918","R918","R6889"],"date":["2024-10-08","2025-08-21","2025-03-14","2025-03-14","2023-12-14","2024-08-12","2024-06-19","2025-06-19","2025-06-19","2024-07-11","2024-05-15","2025-01-07","2023-08-04","2024-01-29","2024-08-12","2023-12-28","2025-08-04","2024-02-02","2024-07-03","2023-08-07","2024-03-01","2024-03-01","2024-03-06","2024-03-06","2024-09-04","2024-02-29","2024-03-01","2024-02-29","2023-09-28","2023-09-28","2023-09-28","2023-12-12","2022-12-15","2024-08-05","2023-06-20","2022-12-19","2025-08-06","2023-11-03","2023-12-30","2024-09-04","2023-12-20","2023-12-20","2024-03-06","2024-02-06","2024-03-01","2024-03-13","2024-03-01","2024-03-07","2024-03-07","2024-03-02","2024-03-02","2024-02-29","2024-07-11","2024-03-02","2023-09-28","2022-10-21","2024-03-06","2023-08-05"],"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":[["","","JANTOVEN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUARIX QUAD 2022-2023","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","AMIODARONE HCL","","","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":""}]}]}