{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brian K Roberge","gend":0,"currentgend":"","add":"3 DODE DR","city":"SACO","state":"ME","zip":"04072","dob":"1964-02-04","age":"","mstatus":"","insh":"10000019349","cliId":"","pno":2078490540,"cno":2078490540,"email":"declined@050324.com","ename":"","eno":"","pphy":"WELCH, JUDY L","ppno":2072830500,"pcpadd":"3 Eastview Pkwy,","pcpcity":"SACO","pcpstate":"ME","pcpzip":"04072","pcpcounty":"","pcpid":"","pcpname":"JUDY WELCH MD PA","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2074947195,"add2":"","add3":"","madd1":"3 DODE DR","madd2":"","madd3":"","mcity":"Saco","mstate":"ME","mzip":"04072","pcpfaxno":2072834207,"pcpnpi":1174519235,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5QM5HU5RK95","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","H5213","E119","D1801","I788","M5450","Z0000","Z720","R29898","L089","E875","F1090","I10","J329","Z23","J0190","B9689","L98491","B999","M549","M21949","F17200","M79645","B360","D492","F1020","S6990XA","L989","R6889","S67191D","I739","M25641","L819","R238","S66921S","S61501S","E785","L0889","L03012","M869","M868X4","S62633A","S60413A","L0390","R2232","F17210","M2550","F1021","Z658","S66921D","S66921A","M6281","S61212D","S61219A","R600","S66112A","S66114A","S66116A","G8918","S61219D","S66112S","S66116S","S66114S"],"date":["2025-07-01","2025-07-01","2025-07-14","2023-11-16","2023-11-16","2023-01-05","2025-05-09","2025-07-28","2022-12-05","2023-01-05","2025-07-29","2025-07-28","2025-07-28","2023-10-12","2023-10-12","2023-10-12","2023-10-12","2022-12-27","2023-01-05","2024-10-11","2024-10-11","2024-10-11","2023-10-23","2023-03-06","2023-03-06","2025-01-17","2023-10-02","2023-10-02","2023-02-15","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-10-23","2023-10-23","2024-05-03","2022-10-17","2022-10-06","2022-10-06","2022-10-06","2022-10-06","2022-09-01","2022-09-01","2022-09-04","2022-09-04","2022-08-31","2022-08-31","2022-08-08","2022-08-02","2022-06-07","2022-06-14","2022-03-28","2022-03-28","2022-03-30","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-28"],"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":[["","","DULOXETINE HCL","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE-OLMESARTAN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}