{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James O Brown","gend":0,"currentgend":"","add":"33 SMITH STREET","city":"North Haven","state":"ME","zip":"04853","dob":"1945-05-09","age":"","mstatus":"","insh":"10000025553","cliId":"","pno":2078672221,"cno":"","email":"candace@americamail.com","ename":"","eno":"","pphy":"SCHUMACHER, GRETCHEN","ppno":2078672021,"pcpadd":"North Haven Medical Clinic,135 Main St","pcpcity":"North Haven","pcpstate":"ME","pcpzip":"04853","pcpcounty":"","pcpid":"","pcpname":"NORTH HAVEN MEDICAL CLINIC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"33 SMITH STREET","madd2":"","madd3":"","mcity":"North Haven","mstate":"ME","mzip":"04853","pcpfaxno":2078672256,"pcpnpi":1235152935,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7N22VY7EW70","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I083","I501","N1831","I2510","E1122","I10","R42","I25118","I5020","I63512","E119","I2699","R918","R0602","R0902","R0609","R5383","R110","R710","N1832","N189","D649","N1830","K219","E1169","E1121","K5730","D509","D631","I739","E538","I255","I5040","I517","I5189","N179","R4701","Z01818","I7092","Z0101","H25813","Z0000","M5451","M62830","M5410","I214","Z743","Z955","D485","D3610","R030","E1129","R809","Z794","E1165","M47812","I5022","E785","I70211","M50321","M4312","J984","D500","I4710","I4720","I959","Z9862","Z5181","I651","I6622","R55","I639","N281","I700","I2609","I110","Z7189","K5731","R5381","D508","K909","Z23","E8720","I081","I2789","I454","J849","R059","I70219","I447","I6782","I5023","E113393","Z1159","Z1331","I7389","R9439","I080","R21","W57XXXA","G8313","E11319","E1136","N181","E7800","R69","I509","I2720","I281","S39012A","S0086XA","E782"],"date":["2025-02-11","2025-04-02","2025-04-05","2025-02-11","2025-08-27","2025-07-15","2025-02-11","2024-11-22","2025-04-17","2024-09-09","2025-05-19","2025-05-14","2025-04-01","2025-04-02","2025-02-13","2024-05-06","2025-05-12","2024-07-22","2024-07-22","2025-09-16","2025-07-28","2025-08-14","2025-03-03","2025-03-03","2023-04-10","2025-01-31","2025-04-03","2025-09-05","2025-09-16","2025-01-17","2025-05-19","2025-05-19","2025-06-13","2025-06-13","2025-06-13","2025-02-14","2025-02-14","2023-11-09","2023-11-16","2023-11-29","2023-11-29","2024-12-02","2022-10-11","2022-10-11","2022-10-11","2025-04-11","2025-04-04","2024-09-16","2022-10-19","2022-10-19","2024-04-17","2024-08-28","2023-11-09","2022-10-11","2024-09-06","2022-10-11","2025-02-18","2024-09-11","2023-11-16","2022-10-11","2022-10-11","2025-02-11","2025-08-07","2024-10-01","2024-10-01","2024-09-06","2023-11-29","2025-03-31","2024-07-22","2024-07-22","2024-09-30","2024-07-24","2024-07-19","2024-07-19","2025-02-17","2025-06-13","2025-02-10","2025-04-02","2023-01-26","2025-06-11","2025-08-22","2024-10-25","2024-07-22","2025-04-02","2025-04-02","2025-04-02","2025-04-01","2024-07-18","2023-10-18","2025-04-02","2024-07-22","2025-04-04","2025-06-10","2022-12-02","2022-12-02","2023-06-13","2024-05-01","2024-07-22","2023-05-09","2023-05-09","2023-08-15","2023-08-15","2023-08-15","2024-09-11","2023-09-11","2024-08-01","2025-03-11","2025-02-11","2025-02-11","2025-08-21","2023-09-20","2022-09-14"],"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":[["","","PROCRIT","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ARANESP","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","EZETIMIBE","","","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":""}]}]}