{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charles V Tanner","gend":0,"currentgend":"","add":"880 Forest Ave Apt 9 8","city":"Portland","state":"ME","zip":"04103","dob":"1948-06-21","age":"","mstatus":"","insh":"10000025929","cliId":"","pno":2076932426,"cno":"","email":"ctanner1@maine.rr.com","ename":"","eno":"","pphy":"Samantha Richards","ppno":2077984050,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"Martins Point Health Care","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"880 Forest Ave Apt 9 8","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04103","pcpfaxno":2077984018,"pcpnpi":1689960114,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6Q20XH5HH37","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25532","I10","E1142","E1122","K635","D122","Z86010","D123","D125","K2270","M19032","D120","Z1211","E1165","Z23","E1121","M19041","G4730","G4739","G4721","E119","N401","Z8042","Z125","M1812","M5450","M5136","M47816","D473"],"date":["2023-01-05","2024-08-30","2024-09-17","2024-08-30","2024-02-27","2024-02-27","2024-02-27","2024-02-27","2024-02-27","2024-02-27","2023-02-14","2023-02-17","2023-02-17","2023-09-01","2024-09-13","2024-08-08","2024-08-30","2023-04-17","2023-04-17","2023-04-17","2025-02-06","2024-09-17","2023-09-11","2023-09-11","2023-01-05","2023-11-03","2023-11-03","2023-11-03","2022-09-06"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ULTICARE PEN NEEDLE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":""}]}]}