{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Warren C Lewis","gend":0,"currentgend":"","add":"56 JEAN ST","city":"Lewiston","state":"ME","zip":"04240","dob":"1947-01-10","age":"","mstatus":"","insh":"10000023097","cliId":"","pno":2072293664,"cno":"","email":"jlewis93419@roadrunner.com","ename":"","eno":"","pphy":"ROBERTS, ALEXANDRA","ppno":2077986200,"pcpadd":"Family Health Care Associates,190 Stetson Rd","pcpcity":"Auburn","pcpstate":"ME","pcpzip":"04210","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"56 JEAN ST","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":2078345388,"pcpnpi":1033562863,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1A80JN4VE29","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R1310","M9901","M9902","M9903","M9904","M533","H43813","H401131","H2511","Z1211","M5450","M461","D122","D175","K5730","R52","Z0389","R079","L821","D225","I788","N393","Z0000","M47818","E0789","K449","K219","E7800","L820","L298","L538","H02403","H02831","H02834","H02135","Z09","H02401","H02402","J3489","I10","M1990","K047","H2512","Z20822","Z01818","J342","J343","K225","M519","R0789","R0982","R102","Z981","M48061","M5136","M4310","M5127","M4316","M47816","M549","M5410","M5126","M4317","M5442","M9905","M546","M5417"],"date":["2025-04-10","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2025-09-17","2024-07-18","2025-09-10","2024-12-10","2025-06-25","2023-11-06","2023-02-09","2025-06-25","2025-06-25","2025-06-25","2025-01-15","2023-02-09","2025-02-11","2024-05-07","2023-01-04","2023-01-04","2023-02-06","2025-05-21","2024-01-30","2025-02-11","2024-02-26","2024-02-19","2024-05-21","2024-05-07","2024-05-07","2024-05-07","2024-06-14","2024-06-14","2023-12-11","2024-06-14","2023-08-14","2024-06-14","2024-06-14","2025-04-30","2025-02-11","2023-09-28","2023-09-28","2024-12-03","2023-02-09","2023-01-31","2025-04-30","2025-04-30","2025-04-30","2023-05-10","2025-02-11","2025-04-23","2025-09-17","2023-05-10","2022-10-03","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-28","2022-09-16","2022-09-20","2022-09-28","2022-09-28","2022-08-29","2022-09-09","2022-09-09","2022-09-09"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","GABAPENTIN","","","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":""}]}]}