{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dewain L Wallace","gend":0,"currentgend":"","add":"9 ROBINSON RD","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1942-08-18","age":"","mstatus":"","insh":"10000024602","cliId":"","pno":2392184579,"cno":"","email":"Dwallace60@yahoo.com","ename":"","eno":"","pphy":"EDWARDS, STEVEN R","ppno":2077998596,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9 ROBINSON RD","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":2078287850,"pcpnpi":1710177936,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2NK0JP3AP28","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I723","H26492","R6889","M9904","M5417","M9903","M5416","M722","D2371","K862","Z0101","N281","N3289","R059","R509","Z0100","R350","Z01812","N390","I10","E1169","E1159","N200","K222","K2100","K449","M9901","M5412","H1132","K219","D017","D490","K2282","K3189","E119","E785","M9902","M5414","I724","Z20822","D378","K2210","R1310","Z8719","N419","Z87448","M25572","Z01818","I2510","R310","Z8349","J0100","M7732","M19072","Z1389","N400"],"date":["2025-02-18","2024-02-01","2023-07-22","2025-05-01","2025-05-01","2025-07-31","2025-07-31","2025-05-02","2025-05-02","2025-04-15","2025-01-13","2025-01-14","2024-10-04","2024-12-10","2024-12-10","2023-01-02","2024-11-26","2025-02-04","2025-01-02","2025-07-09","2025-07-09","2025-07-09","2025-06-30","2023-11-21","2023-05-26","2024-05-20","2025-05-01","2025-05-01","2023-05-30","2024-11-04","2024-11-04","2024-05-20","2024-05-20","2024-05-20","2024-05-20","2024-05-20","2025-07-31","2025-07-31","2025-02-18","2022-11-11","2023-02-21","2023-02-21","2023-02-21","2024-11-04","2024-12-17","2025-06-30","2024-07-08","2025-02-14","2024-07-05","2023-10-05","2024-05-16","2025-05-28","2024-07-05","2024-07-05","2022-09-12","2022-09-12"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","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":{"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":""}]}]}