{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eugene J Lord","gend":0,"currentgend":"","add":"221 SOUTH PRINCETON RD","city":"ALEXANDER","state":"ME","zip":"04694","dob":"1949-04-04","age":"","mstatus":"","insh":"10000019196","cliId":"","pno":2074541337,"cno":"","email":"","ename":"","eno":"","pphy":"JOHNSON, SALLY","ppno":2077965503,"pcpadd":"136 MILL ST,","pcpcity":"PRINCETON","pcpstate":"ME","pcpzip":"46683344","pcpcounty":"","pcpid":"","pcpname":"ST CROIX REGIONAL FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"221 SOUTH PRINCETON RD","madd2":"","madd3":"","mcity":"ALEXANDER","mstate":"ME","mzip":"04694","pcpfaxno":2077965528,"pcpnpi":1457336224,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AA1DY7GY28","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1142","Z79899","E1151","E039","R9720","M549","M25562","E119","C61","I10","C220","K7460","K8020","K862","Z9289","E1340","R739","Z743","R220","Z5329","Z08","Z8505","Z923","Z0000"],"date":["2025-08-13","2024-09-30","2023-08-21","2025-02-05","2023-08-21","2024-03-13","2025-05-14","2025-02-05","2025-07-17","2024-11-13","2025-06-30","2024-02-16","2024-02-16","2024-02-16","2024-02-22","2024-07-15","2025-04-04","2025-04-04","2022-11-03","2022-11-03","2023-03-24","2023-03-24","2023-03-24","2024-11-25"],"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":[["","","CARISOPRODOL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","MORPHINE SULFATE ER","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FAMOTIDINE","","","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":""}]}]}