{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christopher G Milite","gend":0,"currentgend":"","add":"75 S FREEPORT RD","city":"Freeport","state":"ME","zip":"04032","dob":"1946-11-25","age":"","mstatus":"","insh":"10000026891","cliId":"","pno":2078656268,"cno":"","email":"declined@07312025.com","ename":"","eno":"","pphy":"HINE, JENNIFER L","ppno":2077984400,"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":"75 S FREEPORT RD","madd2":"","madd3":"","mcity":"Freeport","mstate":"ME","mzip":"04032","pcpfaxno":2077984018,"pcpnpi":1922031657,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4GA7DD6FH35","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":["R059","M79675","L820","I739","N1831","I480","I743","I4891","N400","Z79899","M79604","I7092","I700","K5730","M7989","J189","I10","N179","J069","I70221","I748","I744","I998","K219","R062","R509","L03116","I70201","Z23","Z6831","I771","Z86718","Z48812","I517","J9601","L989","I749","I4811","J984","N401","R5383","N289","R918","U071","Z0101","I080","I422","R7989","R0602","I4821","D6869","M25512","E669"],"date":["2024-02-26","2025-09-26","2025-03-28","2025-11-19","2025-01-06","2025-01-06","2023-08-02","2023-08-05","2023-08-02","2023-08-02","2023-07-31","2023-08-02","2023-07-31","2023-07-31","2023-07-31","2024-11-19","2023-08-02","2023-06-30","2023-06-25","2023-08-02","2023-08-02","2023-08-05","2023-08-08","2023-08-02","2023-06-25","2023-06-25","2023-08-28","2023-08-01","2025-09-26","2023-08-05","2023-07-31","2024-02-07","2023-09-07","2023-06-27","2023-06-30","2025-03-31","2023-08-02","2023-08-02","2024-05-29","2023-06-29","2024-02-26","2023-01-10","2023-06-25","2025-11-19","2025-10-09","2023-08-02","2023-08-02","2023-06-26","2023-06-25","2022-11-15","2022-11-07","2022-11-07","2022-11-07"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FUROSEMIDE","","","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":""}]}]}