{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Claude Dubois","gend":0,"currentgend":"","add":"21 Carew Dr","city":"Lewiston","state":"ME","zip":"04240","dob":"1945-08-02","age":"","mstatus":"","insh":"10000017703","cliId":"","pno":"","cno":2075769109,"email":"declined@013020.com","ename":"","eno":"","pphy":"Katarina Z Latkovich","ppno":2077955700,"pcpadd":"12 High St,Ste 400 Central Maine Internal Medicine","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"Central Maine Internal Medicine","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"21 Carew Dr","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":2077955727,"pcpnpi":1902878499,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5VD9CF6QY39","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K3532","D6869","Z7901","Z23","R42","R55","K8010","K8000","N138","E1151","I10","K8050","K625","R399","N200","R319","R001","E785","S2239XA","N401","K810","F419","I82409","I480","I2699","S2231XA","I2510","E119","N3281","M542","M62838","Z0101","L570","X32XXXA","L821","L814","D225","D2239","Z0000","D485","K8020","R310","K269","I739","K5792","R109","R140","K820","I6523","Z9049","K3520","I4510","R350","R0781","K828","Z48815","H10812","K3580","R791","D75829","T8089XA","H02846","K264","D62","K921","Z01818","Z86718","K260","R079","N3941","Z043","R6889","K6389","I444","T839XXA","I6529","J189","Z87438","R7989","R609","I872","R0789","I959","I517","K838","N281","I119"],"date":["2023-02-28","2024-07-08","2025-07-07","2023-11-16","2023-10-02","2025-03-05","2024-05-05","2024-05-05","2024-05-05","2024-07-08","2025-02-12","2024-05-04","2024-11-27","2024-07-22","2024-09-17","2025-04-24","2024-05-03","2024-10-02","2025-02-12","2025-07-10","2024-05-03","2024-01-04","2024-12-23","2025-01-20","2024-06-24","2025-02-12","2025-02-12","2025-02-12","2025-07-10","2025-03-04","2025-03-04","2024-12-24","2025-01-08","2025-01-08","2025-01-08","2025-01-08","2025-01-08","2025-01-08","2025-07-08","2025-01-08","2024-05-04","2024-05-15","2023-04-20","2024-06-24","2023-02-25","2024-09-17","2023-03-05","2023-02-25","2024-12-23","2024-05-20","2023-02-28","2023-05-29","2024-07-11","2025-02-12","2024-05-04","2023-03-07","2023-11-01","2023-02-28","2023-02-26","2023-02-26","2023-02-26","2023-02-26","2023-02-28","2023-02-28","2023-02-28","2023-02-27","2023-02-25","2023-02-28","2024-05-03","2025-07-10","2025-02-12","2023-03-01","2023-03-05","2023-02-28","2024-05-15","2024-06-04","2023-02-25","2024-05-17","2023-08-21","2023-08-21","2024-01-03","2025-02-12","2025-02-12","2023-02-28","2024-05-04","2024-05-04","2024-07-08"],"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":[["","","FINASTERIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FONDAPARINUX SODIUM","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","POTASSIUM CITRATE ER","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y 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":""}]}]}