{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Reginald J Fortin","gend":0,"currentgend":"","add":"102 RIVER RD APT 2","city":"Chelsea","state":"ME","zip":"04330","dob":"1947-10-09","age":"","mstatus":"","insh":"10000019280","cliId":"","pno":2075920170,"cno":"","email":"fortinhall@aol.com","ename":"","eno":"","pphy":"SCHIFF SLATER, SCOTT D","ppno":2076260606,"pcpadd":"Hallowell Family Practice,\t9 Union St","pcpcity":"Hallowell","pcpstate":"ME","pcpzip":"04347","pcpcounty":"","pcpid":"","pcpname":"HALLOWELL FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"102 RIVER RD APT 2","madd2":"","madd3":"","mcity":"Chelsea","mstate":"ME","mzip":"04330","pcpfaxno":2076260022,"pcpnpi":1750354957,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3DG5HF8JP84","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11621","L97519","I2510","K7460","F17210","I255","Z23","I779","F1020","I8500","E119","I739","I10","R040","K7030","E871","Z01810","I440","I252","R911","Z1211","D125","I701","N400","K635","K621","M79672","J449","E785","K760","L97529","L97329","E538","F1029","Z122","E1151","L97929","I70223","Z0001","F17200","I70222","I420","I70202","I700","I70235","M79605","M79604","Z95828","Z7182","Z713","I70203","I080","Z0389","F1090","I998","K5730","K648","Z86010","Z1289","K739","H95113","H906","Z974","Z7984","K7689","R932","Z720","H95193","I4510","R9431","Z87891","Z98890","R918"],"date":["2025-02-13","2025-05-02","2025-08-25","2025-05-09","2025-04-29","2025-11-11","2025-11-13","2024-07-31","2023-09-05","2023-09-07","2025-11-11","2025-06-02","2025-11-11","2025-04-03","2025-04-03","2024-12-18","2023-05-09","2023-05-09","2023-05-09","2023-03-30","2025-04-07","2025-04-07","2025-04-21","2025-08-04","2025-04-21","2025-04-21","2023-05-02","2023-06-27","2025-11-11","2023-09-07","2024-08-06","2024-06-04","2023-09-05","2023-09-05","2025-03-17","2025-05-02","2024-08-15","2023-04-14","2025-04-29","2025-02-04","2024-08-27","2023-09-07","2023-04-28","2023-04-28","2025-05-02","2024-08-06","2024-08-06","2025-06-02","2025-04-29","2025-04-29","2023-04-28","2023-07-12","2023-04-14","2023-11-20","2023-05-02","2025-04-07","2025-04-07","2023-11-20","2023-03-09","2023-04-12","2025-01-06","2025-01-06","2025-01-06","2025-02-13","2024-10-01","2024-10-01","2023-05-24","2023-07-06","2023-05-09","2023-05-09","2025-03-17","2025-03-18","2023-03-30"],"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":[["","","CARVEDILOL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DAPAGLIFLOZIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","SIMVASTATIN","","","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":""}]}]}