{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Herbert L Eastman","gend":0,"currentgend":"","add":"922 CUNDYS HARBOR RD","city":"HARPSWELL","state":"ME","zip":"04079","dob":"1945-01-24","age":"","mstatus":"","insh":"10000020179","cliId":"","pno":"","cno":2075221786,"email":"unimogonce@yahoo.com","ename":"","eno":"","pphy":"SHEPHERD, AMBER","ppno":2077984400,"pcpadd":"Sheepscot Valley Health Center,114 Bath Rd","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":"922 CUNDYS HARBOR RD","madd2":"","madd3":"","mcity":"HARPSWELL","mstate":"ME","mzip":"04079","pcpfaxno":"","pcpnpi":1477941425,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8D25AC3CW98","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":["Z98890","J811","R918","I25118","Z48812","J984","H338","B079","R262","Z125","R0789","N5203","N401","N138","L309","L298","Z7189","I2510","R6889","I2089","E785","Z23","Z758","K2270","M9900","M9901","M9902","G8918","J929","R935","I700","I25119","J920","R9389","R0689","R3912","Z951","M79671","Z77090","H04123","R5383","R079","R531","I088","K2080","L03011","Z0101","B351","R7301","I10","I318","I340","N528","J948","R911","R011","Z79891","E782","Z9861","R0609","L989","R030","I6523","I080","J849","H2513"],"date":["2024-11-25","2024-11-25","2024-05-07","2024-11-23","2024-12-12","2024-11-29","2023-06-15","2024-06-27","2024-06-27","2025-05-13","2024-09-12","2023-11-07","2025-05-13","2023-11-07","2024-02-19","2024-02-19","2024-02-19","2025-11-03","2022-12-22","2024-11-08","2025-11-03","2025-05-08","2025-01-02","2024-11-25","2024-11-27","2024-11-27","2024-11-27","2024-11-26","2024-12-12","2022-12-19","2022-12-19","2024-12-16","2024-05-01","2022-12-19","2024-11-19","2025-05-13","2025-10-06","2024-05-24","2024-05-06","2024-05-23","2025-11-03","2024-11-10","2024-11-10","2024-11-20","2024-06-13","2023-11-06","2025-07-01","2024-06-27","2025-05-08","2024-11-25","2024-11-25","2024-11-25","2023-05-08","2024-11-25","2023-05-12","2023-12-15","2025-05-05","2025-04-30","2025-04-30","2024-11-06","2022-12-16","2022-12-16","2024-11-20","2023-12-15","2024-05-01","2022-12-19"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CAPVAXIVE","","","Select","Select",""],["","","HEPLISAV-B","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AREXVY","","","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":""}]}]}