{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George E Parker","gend":0,"currentgend":"","add":"128 SHAW RD","city":"Woolwich","state":"ME","zip":"04579","dob":"1941-05-19","age":"","mstatus":"","insh":"10000025795","cliId":"","pno":2074919400,"cno":"","email":"islandcoveltd@msn.com","ename":"","eno":"","pphy":"GREENLEAF, REBECCA","ppno":2077952800,"pcpadd":"76 HIGH ST FL 1,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2074431362,"add2":"","add3":"","madd1":"128 SHAW RD","madd2":"","madd3":"","mcity":"Woolwich","mstate":"ME","mzip":"04579","pcpfaxno":2077952808,"pcpnpi":1164782819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4GA5TP1DG83","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79643","R296","R2681","H9202","E119","M180","E785","F900","H6122","T24211A","Z0101","H353121","Z01118","S46211A","H9190","E1142","I10","M5450","E1151","R262","B351","M79674","M79675","E669","Z0000","H6092","R0683","R7989","M7989","E559","R600","Z79899","R739","R197","M85842","M19042","M79641","M85841","M1811","S46201A","H9012","M79642","S4991XA","M779","M19011","M79644","M79645","H908","Z09","R809","H903","T162XXD","I499","Z87891","E1100","F419"],"date":["2024-05-10","2025-07-16","2025-07-16","2023-09-13","2025-09-04","2025-07-23","2024-09-09","2024-08-07","2024-01-05","2025-03-21","2024-01-22","2024-01-22","2024-01-05","2024-09-03","2024-01-05","2024-06-21","2023-12-28","2023-12-28","2023-12-28","2024-06-21","2024-10-02","2024-10-02","2024-10-02","2023-03-24","2025-05-29","2023-09-29","2023-05-12","2024-05-21","2024-06-13","2025-09-04","2025-09-04","2024-06-13","2023-02-23","2023-04-17","2024-05-21","2024-05-21","2024-05-21","2024-05-21","2024-05-21","2024-07-28","2024-02-05","2024-05-21","2024-07-28","2024-07-28","2024-07-28","2024-08-05","2024-08-05","2023-12-12","2025-08-29","2024-12-05","2024-02-05","2024-02-05","2025-05-31","2024-07-28","2022-09-26","2022-09-22"],"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":[["","","METHYLPHENIDATE HCL","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LEVEMIR FLEXPEN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CONTOUR NEXT TEST STRIP","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","LEVEMIR FLEXTOUCH","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","INSULIN GLARGINE-YFGN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}