{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert P Blouin","gend":0,"currentgend":"","add":"10 Fox Run Dr","city":"Lewiston","state":"ME","zip":"04240","dob":"1937-11-27","age":"","mstatus":"","insh":"10000022922","cliId":"","pno":2072410351,"cno":9788461709,"email":"declined@071422.com","ename":"","eno":"","pphy":"Mary E Davis","ppno":2077955700,"pcpadd":"12 High St,Ste 400","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"Central Maine Internal Medicine","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 Fox Run Dr","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":2077955727,"pcpnpi":1215917919,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6QM3HQ3AT11","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B351","M79675","M79674","R262","H353132","R918","H18513","H18423","H18593","R079","C801","I4891","Z950","K8020","I10","I2510","K219","N281","R1011","H6691","Z951","K8070","K8010","R1013","K8051","Z20822","R7401","K8050","E806","J449","Z86711","I110","D509","K5900","R748","N401","Z01818","Z5181","Z7901","I4892","S299XXA","S22080A","R6889","R9431","Z48812","K5790","Z96642","K828","R7989","E7800","R911","T169XXA","H6501","R0600","R42","I429","J939","I442","N400","Z0101","R0602","H906","M4624","M4620","S32009A","R7881","I083","D649","L89623","D23111","M4644","G928","K2971","R509","R339","S22080D","W19XXXA","D6869","G44229","M4626","M549","Z0000","R531","M48061","M5126","M5136","M47816","B954","I509","I6782","J984","K3189","M4640","I440","M4646","G629","M5459","M5134","M47814","M5137","M4316","L03115","S22089A","S22000A","W010XXA","Z4800","M5124"],"date":["2025-07-10","2025-07-10","2025-07-10","2025-07-10","2024-10-10","2023-11-10","2024-10-10","2023-09-28","2024-10-10","2023-04-01","2023-11-10","2025-05-22","2025-01-30","2023-04-30","2024-08-02","2024-05-09","2023-03-28","2023-04-01","2023-04-01","2023-10-05","2022-11-02","2023-05-02","2023-05-15","2023-10-05","2023-04-30","2023-05-02","2023-04-30","2023-05-01","2023-05-02","2023-09-21","2023-05-01","2023-05-01","2024-12-05","2023-05-18","2023-05-18","2023-05-01","2023-12-16","2022-08-10","2023-11-16","2024-02-08","2023-11-16","2023-11-16","2023-07-03","2022-08-09","2022-09-28","2023-04-30","2023-04-30","2023-04-30","2023-05-01","2022-11-17","2023-09-21","2023-10-02","2023-10-02","2024-09-13","2022-10-20","2024-05-09","2022-11-11","2025-01-30","2023-09-22","2025-01-29","2022-09-28","2023-08-02","2024-03-05","2024-06-05","2024-01-23","2023-12-29","2023-12-21","2025-01-28","2024-01-25","2024-07-26","2024-04-09","2024-01-02","2024-01-02","2023-12-19","2023-12-19","2023-12-19","2025-01-28","2024-08-02","2024-08-02","2024-02-28","2024-01-03","2024-05-09","2023-12-20","2024-02-09","2024-02-09","2023-12-20","2023-12-20","2023-12-29","2025-01-06","2023-12-24","2023-12-22","2024-01-02","2024-07-10","2024-02-07","2024-02-13","2025-01-28","2024-02-08","2023-12-07","2023-12-07","2023-12-07","2023-12-07","2024-12-22","2023-12-16","2023-12-12","2023-11-16","2024-01-25","2024-02-09"],"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",""],["","","FINASTERIDE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","OXYCONTIN","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","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":""}]}]}