{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter Surek","gend":0,"currentgend":"","add":"142 W MEADOW RD","city":"Thomaston","state":"ME","zip":"04861","dob":"1933-08-05","age":"","mstatus":"","insh":"10000017931","cliId":"","pno":2073546534,"cno":"","email":"","ename":"","eno":"","pphy":"EGGENA, MARK P","ppno":2079215800,"pcpadd":"4 GLEN COVE DR,STE 202","pcpcity":"ROCKPORT","pcpstate":"ME","pcpzip":"04856","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2075920199,"add2":"","add3":"","madd1":"142 W MEADOW RD","madd2":"","madd3":"","mcity":"Thomaston","mstate":"ME","mzip":"04861","pcpfaxno":2075935332,"pcpnpi":1235108580,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2R04G97QU64","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S93401A","E1165","R413","R4689","R42","I495","R0600","Z87891","I2510","I4439","F0390","R4189","I440","I491","I4710","N1830","R609","E1142","Z794","M79674","R55","Z23","E1122","R6889","K449","Z96611","L602","L603","L84","M79604","M25471","G301","E1159","Z0000","F0283","R569","R410","E039","I455","I4430","R002","S91115A","Z515","E11649","I25119","E785","E113299","E10649","Z7985","H35371","Z961","E119","H4321","M79661","L03114","Z955","H35341","F0393","H6123","I083","G309","F0280","I119","M1712"],"date":["2023-09-11","2025-06-23","2024-09-03","2024-07-15","2023-03-03","2025-02-25","2025-01-26","2025-08-02","2024-10-21","2024-07-22","2023-12-27","2024-01-16","2025-02-13","2025-02-13","2025-02-13","2025-07-21","2023-08-15","2023-09-12","2025-02-07","2023-08-10","2024-07-16","2024-10-30","2024-08-09","2024-07-03","2025-01-26","2025-01-26","2025-02-12","2023-08-10","2023-12-14","2023-09-11","2023-09-11","2024-11-06","2024-10-04","2025-03-06","2024-11-06","2023-12-05","2023-12-05","2025-05-12","2024-07-16","2024-07-16","2025-02-25","2023-04-16","2025-06-11","2024-06-02","2023-01-03","2023-05-11","2023-03-30","2025-02-07","2025-02-07","2023-02-02","2023-02-02","2023-04-16","2023-02-02","2023-09-11","2025-08-02","2023-04-16","2023-03-29","2025-06-23","2025-06-23","2024-06-07","2025-02-05","2025-02-05","2022-07-12","2022-07-12"],"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":[["","","CLOPIDOGREL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY READER","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","ULTRA-FINE PEN NEEDLE","","","Select","Select",""],["","","HYOSCYAMINE SULFATE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","PAXLOVID (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":""}]}]}