{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alfred J Legere","gend":0,"currentgend":"","add":"31 WOODLAWN CIR","city":"RANDOLPH","state":"ME","zip":"04346","dob":"1929-12-22","age":"","mstatus":"","insh":"10000024021","cliId":"","pno":2075887284,"cno":"","email":"MaineLegeres@gmail.com","ename":"","eno":"","pphy":"MILLER, ROY S","ppno":2075497581,"pcpadd":"PO BOX 207,","pcpcity":"COOPERS MILLS","pcpstate":"ME","pcpzip":"43410207","pcpcounty":"","pcpid":"","pcpname":"SHEEPSCOT VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"31 WOODLAWN CIR","madd2":"","madd3":"","mcity":"RANDOLPH","mstate":"ME","mzip":"04346","pcpfaxno":"","pcpnpi":1700854361,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5MG4HP1PF68","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R310","C61","Z466","R9720","C7951","M8580","I10","L570","L578","L905","Z85828","R911","D869","R590","Z0000","Z191","Z79818","Z950","I480","K7689","N281","M25552","R079","S39012D","X500XXD","Z5111","L84","M1612","C7911","Z7183","M160","M25559","M5136","Z45018","H6123","M5442","C44319","N320","Z1283","Z0101","Z803","Z800","E782","M85852","M85851","M5450","K5900","Z13820","Z1379","M47816","M4316","M549","I442","Z86018","Z872","L820","M25561","A6929","E663"],"date":["2024-03-05","2025-10-02","2024-03-07","2024-05-25","2025-03-19","2025-01-31","2025-07-14","2024-07-16","2022-11-28","2023-06-22","2024-07-16","2024-04-03","2024-04-03","2024-04-03","2025-01-13","2024-04-03","2024-04-03","2025-10-27","2024-07-19","2024-02-12","2024-02-12","2023-03-21","2025-09-07","2023-05-25","2023-05-25","2025-08-01","2023-06-22","2023-03-20","2024-05-31","2024-05-30","2023-03-20","2023-05-25","2023-05-25","2024-01-05","2025-05-05","2023-03-03","2024-06-17","2025-03-19","2024-01-04","2024-07-09","2024-05-07","2024-05-07","2023-08-08","2024-04-16","2024-04-16","2023-02-20","2023-02-20","2024-04-16","2024-04-25","2023-03-03","2023-03-03","2023-03-03","2024-07-19","2024-07-16","2024-07-16","2022-12-19","2022-09-26","2022-09-26","2022-09-26"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","MORPHINE SULFATE","","","Select","Select",""],["","","ERLEADA","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","BICALUTAMIDE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}