{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kurt W Lutz","gend":0,"currentgend":"","add":"38 BLUFF RD","city":"Yarmouth","state":"ME","zip":"04096","dob":"1946-05-16","age":"","mstatus":"","insh":"10000026469","cliId":"","pno":2053321239,"cno":"","email":"WENDYANDKURTLUTZ@GMAIL.COM","ename":"","eno":"","pphy":"PHAN, ANDREW T","ppno":2078282402,"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":"38 BLUFF RD","madd2":"","madd3":"","mcity":"Yarmouth","mstate":"ME","mzip":"04096","pcpfaxno":2078287850,"pcpnpi":1619918307,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6CP3WQ5DW87","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C155","Z5112","Z5111","C160","C4330","Z0101","Z803","K4090","D6481","Z79899","R6889","J939","M79604","M79605","M21372","G6289","I781","L821","Z85820","L820","R110","K2100","D509","M5117","M4726","G5732","G541","Z7189","R739","J850","J984","J479","M5126","M51369","M47816","T80212A","J181","J90","Z85528","N281","N289","E039","K5900","Z8501","Z8571","C649","C751","R609","N200","N400","K769","C159","Z08","Z923","R160","K219","E782","R4182","C169","J9811","R9431","R7881","J9589","K3189","C229","K56609","N401","R1310","Z980","Z8719","Z7183","R079","Z4682","R109","C227","T827XXA","I872","A4101","K7689","E860","Z23","Z9049","R300","A000","A419","M5414","R946","M47812","H02002","R918","K5650","Z125","Z7982","I959","R29898","C801","C787","Z4889","Z96652","N399","J95811","R933","G8918","Z48813","J189","Z48812","J982","Z98890","Z9221","K660","J948","J918","Z510","S46001D"],"date":["2025-04-30","2025-09-23","2025-09-23","2025-10-31","2025-10-31","2025-09-05","2025-01-07","2024-06-06","2025-09-23","2025-07-22","2023-01-01","2022-11-28","2024-10-17","2024-10-17","2025-01-03","2025-01-03","2023-05-17","2023-05-17","2023-05-17","2023-05-17","2023-09-18","2023-09-18","2025-02-11","2024-10-17","2024-10-17","2025-01-03","2025-01-03","2023-01-12","2023-09-05","2022-12-05","2023-08-24","2023-08-24","2024-12-09","2024-11-14","2024-11-14","2025-11-05","2023-01-18","2025-11-01","2023-04-17","2024-08-09","2023-08-24","2025-11-11","2022-12-07","2023-01-13","2023-02-08","2023-05-08","2023-05-08","2025-06-03","2024-08-09","2024-08-09","2023-10-03","2024-04-19","2023-01-13","2023-01-13","2023-09-14","2025-11-03","2025-11-11","2024-08-07","2024-01-12","2022-12-07","2025-11-05","2025-11-11","2025-11-05","2024-08-07","2023-10-03","2023-02-09","2023-03-20","2024-08-07","2024-08-07","2023-06-08","2023-06-08","2025-11-02","2023-02-08","2023-02-08","2023-10-03","2025-11-03","2025-11-03","2025-11-05","2023-09-11","2023-07-03","2024-11-13","2023-02-08","2022-12-01","2025-11-06","2025-11-01","2024-10-17","2025-05-06","2024-10-17","2025-10-01","2023-06-14","2023-02-08","2024-11-08","2023-02-08","2023-11-07","2024-10-17","2024-10-17","2024-10-17","2024-06-26","2022-12-22","2022-11-25","2022-11-12","2022-10-24","2022-11-20","2022-11-13","2022-11-19","2022-11-19","2022-11-09","2022-11-09","2022-11-09","2022-11-09","2022-11-18","2022-11-18","2022-08-05","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":[["","","OLANZAPINE ODT","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METHYLPHENIDATE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","ARANESP","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","LINEZOLID","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ALFUZOSIN HCL ER","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}