{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Timothy F Coye","gend":0,"currentgend":"","add":"7 NO BEECH RD","city":"HARRISON","state":"ME","zip":"04040","dob":"1947-07-02","age":"","mstatus":"","insh":"10000026558","cliId":"","pno":2075839064,"cno":6175920942,"email":"tfcoye12@gmail.com","ename":"","eno":"","pphy":"BERGERON POULIN, CHARLES KEVIN","ppno":2076936106,"pcpadd":"76 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"NORTH BRIDGTON FAMILY PRACTICE AND WALK IN CLINIC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 NO BEECH RD","madd2":"","madd3":"","mcity":"HARRISON","mstate":"ME","mzip":"04040","pcpfaxno":2076934026,"pcpnpi":1992291249,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6A42JP3EE06","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E785","Z0000","Z1159","R0609","I350","E119","I5020","R2231","I110","I5023","G300","R0602","I509","R42","Z7982","C44622","L570","L718","L821","D1801","L814","Z23","D492","F331","R0600","S01312A","R4182","L858","S40029A","C4491"],"date":["2025-10-28","2024-01-31","2025-06-25","2024-01-31","2025-07-11","2025-07-16","2025-10-06","2025-10-01","2024-08-20","2025-07-14","2025-07-16","2025-04-05","2025-07-03","2025-07-15","2025-03-18","2025-03-18","2025-02-18","2023-03-21","2023-03-21","2023-03-21","2023-03-21","2023-03-21","2024-12-18","2025-01-07","2024-01-31","2025-07-14","2024-11-22","2025-07-14","2025-01-07","2024-08-08","2024-12-18"],"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":[["","","FARXIGA","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","VENLAFAXINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}