{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Herby J Clavette","gend":0,"currentgend":"","add":"14 Chris Ave","city":"Sabattus","state":"ME","zip":"04280","dob":"1940-05-03","age":"","mstatus":"","insh":"10000021940","cliId":"","pno":2073754592,"cno":"","email":"","ename":"","eno":"","pphy":"Adam Duquette","ppno":2077847388,"pcpadd":"190 Stetson Rd,","pcpcity":"Auburn","pcpstate":"ME","pcpzip":"42107813","pcpcounty":"","pcpid":"","pcpname":"Family Health Care Associates","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"14 Chris Ave","madd2":"","madd3":"","mcity":"Sabattus","mstate":"ME","mzip":"04280","pcpfaxno":2077952043,"pcpnpi":1679884522,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7FW0MV1NF49","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","R7989","I10","Z87891","I4819","K921","M5136","M5126","Z0000","M4807","M6281","S0990XA","J9601","D649","R55","Z95818","R918","N289","R32","Z09","D62","K922","R911","J90","J984","I5022","R0602","Z20822","K269","Z7901","E119","I5032","I110","I517","K222","K449","R7303","I499","I340","Z872","Z08","Z85828","C44311","M5450","D500","R0600","R519","R0902","S0083XA","I4821","R350","Z043","R930","I509","N2889","N400","Z006","R109","K6389","M6289","L989","J342","M50323","M50322","M25512","M19012","S4292XA","R319","W1830XA","W19XXXA","I341","C3412","D485","J449","L570"],"date":["2024-12-26","2023-06-03","2025-03-20","2023-06-03","2024-10-21","2023-06-16","2022-12-01","2022-12-01","2024-12-20","2023-01-03","2023-01-03","2023-08-18","2025-07-06","2024-12-19","2025-02-12","2025-07-15","2024-11-21","2023-11-07","2023-10-24","2025-01-06","2023-07-06","2023-07-06","2025-07-22","2024-10-22","2023-06-03","2023-06-03","2024-12-26","2023-06-03","2023-06-16","2024-06-13","2025-04-24","2023-06-05","2025-01-31","2023-06-05","2023-06-16","2023-06-16","2023-12-13","2025-07-15","2025-05-30","2024-03-28","2024-03-28","2024-03-28","2024-01-25","2022-12-01","2023-07-27","2025-02-28","2023-06-30","2025-06-19","2023-08-18","2024-06-26","2024-01-18","2023-06-18","2023-06-18","2025-01-01","2023-11-07","2023-11-07","2024-06-26","2023-06-30","2023-06-30","2024-03-12","2023-06-01","2023-08-18","2023-08-18","2023-08-18","2023-08-18","2023-08-18","2023-08-18","2024-01-18","2023-08-18","2023-06-30","2024-08-14","2025-05-05","2023-11-30","2025-06-19","2024-01-25"],"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":[["","","ANORO ELLIPTA","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","XARELTO","","","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":""}]}]}