{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kenneth Knowles","gend":0,"currentgend":"","add":"39 CARIBOU RD","city":"Presque Isle","state":"ME","zip":"04769","dob":"1939-12-18","age":"","mstatus":"","insh":"10000018430","cliId":"","pno":2077646605,"cno":"","email":"kknowles2009@hotmail.com","ename":"","eno":"","pphy":"GROVER, ELEANOR V","ppno":2077647200,"pcpadd":"\tFull Circle Health Care,169 Academy St Ste C","pcpcity":"Presque Isle","pcpstate":"ME","pcpzip":"04769","pcpcounty":"","pcpid":"","pcpname":"FULL CIRCLE HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1749","madd2":"","madd3":"","mcity":"Presque Isle","mstate":"ME","mzip":"04769","pcpfaxno":2077647204,"pcpnpi":1730191172,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2T30DA7EG17","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E0840","F3289","I10","J449","L603","C3412","E118","E782","D509","E8342","M79671","M25551","M1610","I5032","C3490","L02619","F17200","Z98890","M5430","I4891","C3492","E1151","Z0100","E1165","M8008XA","G2581","C7972","R911","H52223","H524","M5116","R531","E1142","T8189XD","Z4789","L602","R200","J189","R0602","R509","R112","Z20828","M1611","Z48817","M47819","M5136","E11621","U071","G8929","Z923","Z902","E279"],"date":["2023-12-01","2023-12-01","2023-12-01","2025-08-22","2025-06-20","2022-11-09","2025-08-22","2025-08-22","2025-08-22","2025-08-22","2024-03-26","2023-10-16","2023-10-03","2023-10-16","2025-05-08","2025-05-08","2024-04-09","2024-06-07","2023-10-03","2025-06-28","2024-10-24","2024-01-04","2024-09-30","2024-09-30","2024-11-01","2025-06-28","2023-01-19","2022-12-12","2022-12-14","2022-12-14","2023-12-20","2023-06-09","2024-04-29","2024-05-03","2024-05-13","2023-09-07","2023-09-07","2023-03-30","2023-02-20","2023-02-20","2023-02-20","2023-02-20","2023-09-11","2024-04-19","2023-09-11","2023-09-11","2024-08-08","2022-09-27","2022-08-19","2022-06-24","2022-06-16","2022-06-16"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","COMBIVENT RESPIMAT","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MORPHINE SULFATE ER","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","FLUCONAZOLE","","","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":""}]}]}