{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David Wadleigh","gend":0,"currentgend":"","add":"711 SMITHFIELD RD","city":"Belgrade","state":"ME","zip":"04917","dob":"1946-06-26","age":"","mstatus":"","insh":"10000025346","cliId":"","pno":2074652372,"cno":"","email":"bndwadleigh@gmail.com","ename":"","eno":"","pphy":"JUAT, GENESIS E","ppno":2076243800,"pcpadd":"Winthrop Family Medicine,16 Commerce Plaza Ste 3A","pcpcity":"Winthrop","pcpstate":"ME","pcpzip":"04364","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"711 SMITHFIELD RD","madd2":"","madd3":"","mcity":"Belgrade","mstate":"ME","mzip":"04917","pcpfaxno":2076243845,"pcpnpi":1851646707,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4TC9G17HP21","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01810","M1612","I498","R9431","I252","I2510","I493","M25561","M25552","Z923","Z8546","M160","C61","S46912A","W1830XA","I10","E785","Z01818","Z1211","E6601","M159","Z471","M1611","K5730","Z86010","M1711","Z7982","R9721","Z9079","Z955","S0990XA","I4720","I491","I4710","S8392XA","M1712","Z96652","I517","M25512","C7982","Z125","G2581","M7989","Z136","Z23","Z98890","R6889","X58XXXA","D1721","Z4789","S30861A","W57XXXA","Z0001","R0989","K635","Z96642","R9720","Z711","R2231","M79672","M79652","R1032","R600"],"date":["2025-03-26","2025-06-02","2024-08-13","2024-09-26","2024-10-15","2025-05-20","2025-01-30","2024-10-30","2025-04-15","2024-10-24","2024-10-24","2024-10-24","2024-10-24","2025-02-20","2025-02-20","2025-05-20","2025-08-25","2025-04-15","2024-02-12","2024-08-27","2024-08-27","2025-08-04","2025-04-15","2024-02-12","2024-02-12","2024-10-30","2025-02-25","2025-06-06","2024-05-08","2025-05-20","2025-02-20","2024-10-02","2024-10-02","2024-10-02","2024-10-27","2024-06-28","2024-05-16","2025-02-25","2025-02-25","2024-11-13","2024-05-01","2024-05-09","2024-10-27","2024-03-29","2024-10-21","2024-12-03","2023-08-09","2024-10-27","2025-09-29","2025-04-30","2025-06-09","2025-06-09","2025-09-02","2023-05-24","2023-03-31","2025-07-01","2023-04-19","2023-06-13","2025-09-29","2022-10-06","2022-11-01","2022-08-11","2022-08-29"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","LIDOCAINE-PRILOCAINE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","TIZANIDINE HCL","","","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":""}]}]}