{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jeffrey A Lang","gend":0,"currentgend":"","add":"219 FRANKLIN ST","city":"Rumford","state":"ME","zip":"04276","dob":"1947-08-01","age":"","mstatus":"","insh":"10000018817","cliId":"","pno":2073575507,"cno":2073572507,"email":"connielang51@yahoo.com","ename":"","eno":"","pphy":"LEEDS, JESSE","ppno":"","pcpadd":"149 NORTH ST,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49014974","pcpcounty":"","pcpid":"","pcpname":"SWIFT RIVER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"219 FRANKLIN ST","madd2":"","madd3":"","mcity":"Rumford","mstate":"ME","mzip":"04276","pcpfaxno":2078615001,"pcpnpi":1487279162,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9A85RX6QY65","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1165","E119","E6601","I10","E113211","E113212","E785","H903","I119","E113291","R6889","E113292","H1033","R059","R918","J984","Z0000","E1151","M159","J069","Z0101","H5203","E103211","M19041","I2510"],"date":["2024-06-10","2025-09-29","2024-06-10","2024-06-10","2025-09-15","2025-09-15","2024-01-29","2025-05-07","2024-04-22","2024-04-22","2023-06-15","2023-01-09","2023-01-09","2024-02-23","2023-01-04","2023-01-04","2022-12-13","2023-11-28","2024-04-22","2024-02-23","2025-09-25","2025-09-25","2022-11-11","2022-10-24","2022-10-24"],"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":[["","","CELECOXIB","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","PIOGLITAZONE HCL","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","SHINGRIX","","","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":{"indx":[],"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":""}]}]}