{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Larry Coffin","gend":0,"currentgend":"","add":"2 ROBINSON AVE","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1941-08-23","age":"","mstatus":"","insh":"10000018809","cliId":"","pno":2077293982,"cno":"","email":"casket93@gmail.com","ename":"","eno":"","pphy":"GARDINER, PAMELA A","ppno":2077984050,"pcpadd":"Martins Point Healthcare,74 Baribeau Dr","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2 ROBINSON AVE","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":2078287850,"pcpnpi":1023030020,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4NU6RT4PG89","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R32","I509","S0101XA","T796XXA","M6281","I10","R0602","R55","R9439","L03119","M5450","S0181XA","G9389","J320","R600","S22060D","I2510","I4510","I700","I5033","G319","R410","R0600","I517","R531","I080","I2720","I501","S199XXA","M47812","M4802","R4189","I422","I5040","I358","M5459","M7989","S299XXA","S0990XA","T148XXA","R4182","I5032","K219","G609","S22069D","R262","F0390","K5900","I6782","L304","S81802D","L03116","B372","R2689","C61","Z13228","Z1329","G9009","N390","M7581","R5381","R739","K449","I77810","M25511","M546","R109","I6523","I872","M79604","T83511A","R404","S01112D","R269","Z8546","R319","J984","Z0389","M19011","I110","Z736","W19XXXA"],"date":["2025-08-08","2024-07-30","2025-03-25","2025-03-25","2025-03-25","2025-03-25","2025-06-26","2024-04-29","2024-04-23","2025-07-07","2024-04-19","2025-03-25","2024-04-21","2025-03-25","2024-08-16","2025-04-19","2025-03-25","2024-04-22","2024-04-22","2025-07-07","2025-03-25","2025-02-21","2025-05-11","2025-05-11","2025-03-25","2025-03-27","2025-03-27","2025-03-27","2025-03-25","2025-03-25","2025-03-25","2025-02-21","2024-04-20","2024-04-20","2024-04-20","2025-04-01","2025-03-26","2025-03-25","2025-03-25","2024-10-25","2024-12-07","2025-06-20","2024-04-19","2024-04-19","2025-04-15","2025-04-15","2025-04-15","2025-04-15","2024-12-27","2025-06-13","2025-05-15","2025-06-25","2025-05-10","2025-05-10","2023-07-21","2023-07-21","2023-07-21","2024-06-01","2025-05-29","2022-12-20","2025-03-28","2024-07-26","2025-05-11","2025-05-11","2022-12-20","2024-04-17","2024-04-17","2025-02-21","2023-09-05","2025-05-29","2025-05-29","2025-08-08","2025-04-02","2024-04-30","2023-07-21","2025-05-26","2025-06-25","2025-06-25","2022-12-20","2025-06-25","2024-04-29","2024-04-29"],"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":[["","","FUROSEMIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","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":""}]}]}