{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elmer A Naigle","gend":0,"currentgend":"","add":"38 RAY ST","city":"Portland","state":"ME","zip":"04103","dob":"1947-05-05","age":"","mstatus":"","insh":"10000020581","cliId":"","pno":2077976985,"cno":"","email":"","ename":"","eno":"","pphy":"MERCIER, CHRISTOPHER F","ppno":"","pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"38 RAY ST","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04103","pcpfaxno":"","pcpnpi":1396151619,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9AT3JP0KM01","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":["H47233","H40013","I1A0","I10","H6122","H2511","H2512","I340","I119","I77819","M50123","M7711","Z8546","E875","H2513","R7301","C61","M5030","H43813","Z961","E785","M160","M25551","M1611","E8352","K219","K635","Z86010","K5730","K2270","M542","L821","L905","M47812","K449","I493","Z79899"],"date":["2024-10-11","2024-10-11","2025-10-15","2025-10-15","2023-03-28","2023-06-08","2023-06-22","2025-11-03","2025-11-03","2025-11-03","2023-09-25","2023-09-25","2024-10-09","2024-10-28","2023-06-22","2025-04-08","2025-10-14","2023-08-08","2024-01-24","2023-07-20","2025-04-08","2024-11-12","2024-12-16","2024-12-16","2025-09-29","2023-06-08","2023-11-01","2023-11-01","2023-11-01","2023-11-01","2023-08-08","2024-07-22","2024-07-22","2024-01-02","2023-11-01","2025-10-15","2025-10-15"],"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",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","INDAPAMIDE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","OLMESARTAN MEDOXOMIL","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}