{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gary S Hartley","gend":0,"currentgend":"","add":"109 MECHANIC ST","city":"Presque Isle","state":"ME","zip":"04769","dob":"1944-10-21","age":"","mstatus":"","insh":"10000021506","cliId":"","pno":2074784462,"cno":"","email":"Hartgs63@yahoo.com","ename":"","eno":"","pphy":"SWANBERG, CALEB","ppno":"","pcpadd":"Pines Health Services,74 Access Highway","pcpcity":"Caribou","pcpstate":"ME","pcpzip":"04736","pcpcounty":"","pcpid":"","pcpname":"PINES CARIBOU HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"109 MECHANIC ST","madd2":"","madd3":"","mcity":"Presque Isle","mstate":"ME","mzip":"04769","pcpfaxno":2074926260,"pcpnpi":1013396548,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4VQ4E66TN91","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z4509","I639","D735","R55","E119","M5450","Z8673","G8929","M48061","M5386","I2510","N10","H43813","N184","R410","J189","G9341","N179","R509","I129","Q2112","N1830","R401","Z743","I10","I499","M609","R053","R911","I081","R9431","M2560","N12","N200","G9340","N189","D649","R0602","I6389","M5126","M5136","R29818","G9389","H43812","H02889","Z01812","N1330","N281","K5730","K5900","J984","K5732","N132","R319","I083","Z7902","R1032","N201","I252"],"date":["2025-06-05","2024-04-18","2024-06-21","2024-04-19","2025-02-05","2024-01-03","2023-03-02","2023-05-01","2024-04-21","2023-05-01","2025-05-16","2024-05-06","2022-10-07","2025-09-09","2024-04-22","2024-04-23","2024-04-20","2024-04-24","2024-04-23","2024-07-03","2024-07-03","2024-07-03","2024-04-18","2024-04-18","2024-04-24","2024-04-18","2024-02-01","2025-08-18","2025-08-18","2024-06-21","2024-06-21","2023-12-01","2024-04-29","2024-04-20","2024-04-21","2024-04-24","2025-05-06","2024-04-21","2024-04-18","2024-04-21","2024-04-21","2024-04-18","2024-04-20","2023-10-13","2023-10-13","2023-03-28","2025-09-08","2023-03-28","2024-04-20","2024-04-20","2024-04-20","2022-12-28","2022-12-28","2022-12-28","2024-04-30","2023-03-02","2022-12-29","2022-09-23","2022-09-22"],"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":[["","","CLOPIDOGREL","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ULTRA-FINE PEN NEEDLE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":""}]}]}