{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Calvin A Jeanroy","gend":0,"currentgend":"","add":"84 STEAM MILL RD","city":"Robbinston","state":"ME","zip":"04671","dob":"1948-10-14","age":"","mstatus":"","insh":"10000027519","cliId":"","pno":2074540415,"cno":"","email":"","ename":"","eno":"","pphy":"LUTHIN, SUSAN L","ppno":2078763547,"pcpadd":"118 MOOSEHEAD TRL,STE 5","pcpcity":"NEWPORT","pcpstate":"ME","pcpzip":"49534055","pcpcounty":"","pcpid":"","pcpname":"EASTPORT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 85","madd2":"","madd3":"","mcity":"Robbinston","mstate":"ME","mzip":"04671","pcpfaxno":2078763328,"pcpnpi":1356383962,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6DJ6C38XN65","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N179","I10","Z48816","Z0000","N401","R600","R7302","E559","E782","Z1211","Z86010","D122","K5730","H25813","R918","N390","N132","R339","N411","Z83719","D126","Z466","E039","J449","R338","R7401","N1330","Z23","Z0101","H524","N400","R945","K8020","T83511D","E8342","R300","N138","Z9079","K5900","R030"],"date":["2023-09-10","2025-08-01","2024-09-03","2023-12-06","2025-04-22","2023-09-12","2025-08-01","2025-01-22","2025-08-01","2024-01-03","2024-01-03","2024-01-03","2024-01-03","2023-10-10","2023-09-12","2024-07-25","2023-09-10","2024-05-10","2024-05-10","2023-11-09","2023-11-09","2024-05-14","2025-08-01","2025-08-07","2024-02-15","2023-09-20","2023-09-21","2025-04-01","2025-09-16","2025-09-16","2023-09-10","2023-09-10","2023-09-12","2024-08-01","2024-01-31","2024-08-01","2025-04-22","2025-04-22","2023-09-05","2024-01-15"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}