{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Douglas A Dickey","gend":0,"currentgend":"","add":"78 WHITTEN RD","city":"KENNEBUNK","state":"ME","zip":"04043","dob":"1947-06-12","age":"","mstatus":"","insh":"10000018697","cliId":"","pno":2079858839,"cno":2072298839,"email":"dadickey@icloud.com","ename":"","eno":"","pphy":"COTE, JEFFREY T","ppno":2076460676,"pcpadd":"Wells Family Practice,59 Mile Rd","pcpcity":"Wells","pcpstate":"ME","pcpzip":"04090","pcpcounty":"","pcpid":"","pcpname":"WELLS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"78 WHITTEN RD","madd2":"","madd3":"","mcity":"KENNEBUNK","mstate":"ME","mzip":"04043","pcpfaxno":2076466513,"pcpnpi":1467544668,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1U81PM0EP18","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z4732","Z471","M25552","Z96642","Z01818","L209","Z96612","M19011","Z96611","M25512","T8452XD","M19012","D485","T84019D","M25551","H8112","Z96643","D492","I10","M94212","M75112","Z0101","Z96649","E782","L89312","B9561","Z01811","Z7189","Z0000","M25511","R7301","L308","R011","I517","L03115","L570","E785","G8918","E669","R413","T84018A","D045","Z1331","M19019","L853","R6889","L578","L814","A4101","T8459XD","T8452XS","T8452XA","R7881","A4181","M869","K6812","N179","A4901","M79652","I083","D649","M25462","M5459","M9902","M9903","M9904","R188","R6520","R591","M5127","M47817","M4316","I350","T148XXA","T84091A","Z7401","M25452","J9811","L03116","I38","I808","Z452","L02415","R590","I708","Z96652","Z87891","U071"],"date":["2023-05-06","2024-10-30","2023-07-26","2024-01-12","2024-04-16","2025-01-17","2025-02-04","2024-09-05","2025-10-28","2025-01-29","2023-04-11","2024-10-10","2024-02-07","2022-11-28","2022-11-28","2023-06-22","2023-01-05","2025-10-22","2025-06-16","2024-10-10","2024-10-10","2025-08-14","2024-01-12","2024-06-08","2023-05-06","2023-05-06","2024-04-12","2025-06-27","2025-06-27","2024-05-03","2024-12-13","2023-06-28","2024-04-29","2024-04-29","2025-06-13","2025-10-22","2024-10-10","2024-10-10","2024-12-13","2024-12-13","2023-01-05","2025-03-26","2025-06-27","2024-04-11","2023-02-14","2023-07-28","2023-06-21","2023-06-21","2022-09-26","2022-09-12","2022-08-09","2022-08-25","2022-08-25","2022-08-29","2022-08-16","2022-07-21","2022-07-25","2022-08-01","2022-07-19","2022-07-20","2022-08-01","2022-07-21","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-07-25","2022-07-21","2022-07-25","2022-07-17","2022-07-17","2022-07-17","2022-07-18","2022-07-26","2022-07-27","2022-07-27","2022-07-18","2022-07-17","2022-07-17","2022-07-20","2022-07-25","2022-07-26","2022-07-15","2022-07-14","2022-07-15","2022-07-12","2022-07-12","2022-07-01"],"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":[["","","ABRYSVO","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","DUPIXENT PEN","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","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":""}]}]}