{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alec M Diamon","gend":0,"currentgend":"","add":"1006 HERNIA HILL UNIT 23","city":"Carrabassett Valley","state":"ME","zip":"04947","dob":"1948-10-07","age":"","mstatus":"","insh":"10000027532","cliId":"","pno":2072352325,"cno":"","email":"","ename":"","eno":"","pphy":"MILLER, ROY S","ppno":2075497581,"pcpadd":"PO BOX 207,","pcpcity":"COOPERS MILLS","pcpstate":"ME","pcpzip":"43410207","pcpcounty":"","pcpid":"","pcpname":"SHEEPSCOT VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1006 HERNIA HILL UNIT 23","madd2":"","madd3":"","mcity":"Carrabassett Valley","mstate":"ME","mzip":"04947","pcpfaxno":"","pcpnpi":1700854361,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8V86Q56VW83","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C4442","D044","S7001XA","Z452","Z01818","Z08","G43809","R194","C210","S838X1A","E119","E785","H25811","D485","L821","L814","Z85048","Z9221","Z923","H25812","N3289","R519","D489","Z0000","Z13220","Z1329","I10","H903","J3489","J342","I3481","I700","R9341","I440","Z0101","C44500","Z0389","M25551","M25561","M1711","M25461","L570","D492","H6123","I739","R7303","R198","X32XXXA","H6122"],"date":["2025-02-10","2025-02-10","2023-10-21","2023-02-16","2023-02-09","2025-08-19","2025-06-17","2025-01-13","2025-09-18","2023-10-21","2025-10-09","2023-10-21","2024-11-06","2025-05-07","2025-11-13","2025-11-13","2025-08-19","2025-08-19","2025-08-19","2024-10-23","2024-07-08","2023-11-13","2023-05-04","2025-03-28","2025-03-28","2025-03-28","2025-03-28","2025-03-13","2023-09-22","2023-11-13","2023-07-06","2023-07-06","2023-07-06","2023-02-09","2024-04-09","2023-01-03","2025-08-08","2023-10-21","2023-10-21","2023-10-21","2023-10-21","2025-11-13","2024-12-05","2024-10-18","2023-02-16","2023-06-16","2023-01-03","2025-11-13","2022-10-03"],"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":[["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","METFORMIN HCL ER","","","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":{"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":""}]}]}