{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Edward O Soucy","gend":0,"currentgend":"","add":"42 COUNTRY LN","city":"Harrison","state":"ME","zip":"04040","dob":"1947-06-05","age":"","mstatus":"","insh":"10000023823","cliId":"","pno":2075836394,"cno":"","email":"","ename":"","eno":"","pphy":"STADNICKI, MICHAEL R","ppno":2077537655,"pcpadd":"12 HIGH ST,STE 302","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"NORTH BRIDGTON FAMILY PRACTICE AND WALK IN CLINIC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"42 COUNTRY LN","madd2":"","madd3":"","mcity":"Harrison","mstate":"ME","mzip":"04040","pcpfaxno":2077537656,"pcpnpi":1831179803,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2PR1Y58MX39","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47816","M5136","M5450","R198","I10","E119","E785","H903","Z0000","C679","L280","Z0100","M25552","K631","I6523","I422","I358","I517","R011","K644","G4762","Z136","D3131","R072","L98419","R234","R509","L218","L814","D225","L821","D485","L820","L538","L298","M2021","M2022","M79671","M79672","R5383","R109","N3289","I700","N2889","K9189","D120","K5730","E669","K219","L570","X32XXXA","D124","K621","D649","K828","K439","G8918","K625","Z0101","M792","Z0389","M159","R059","Z23","M109","M19072","M2142","M7989","M25572","M25571","M2141","Z08"],"date":["2022-12-05","2022-12-05","2025-01-06","2024-05-29","2024-05-29","2025-05-16","2024-05-29","2025-06-18","2024-10-23","2025-10-29","2023-10-31","2024-05-10","2025-03-04","2024-06-04","2023-05-02","2024-04-02","2023-10-27","2023-10-27","2024-01-23","2024-05-17","2023-08-25","2023-12-27","2024-05-10","2025-01-31","2023-10-19","2023-10-19","2023-06-20","2025-10-23","2025-10-23","2025-10-23","2025-10-23","2023-10-19","2023-10-19","2023-10-19","2023-10-19","2022-12-06","2022-12-06","2022-12-06","2022-12-06","2024-04-02","2024-05-23","2024-05-23","2024-05-23","2024-05-28","2024-05-23","2024-05-21","2024-05-21","2024-05-21","2024-05-21","2025-10-23","2025-10-23","2024-05-21","2024-05-21","2024-10-23","2024-05-28","2024-05-28","2024-05-23","2024-05-21","2025-05-16","2025-01-06","2024-05-23","2025-04-24","2023-06-20","2022-10-25","2022-11-10","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-10-12"],"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":[["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TIADYLT ER","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","ALCLOMETASONE DIPROPIONATE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PROCTO-MED HC","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","AMOXICILLIN","","","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":""}]}]}