{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Samuel R Profenno","gend":0,"currentgend":"","add":"18 DUNSTAN LANDING RD","city":"Scarborough","state":"ME","zip":"04074","dob":"1947-01-31","age":"","mstatus":"","insh":"10000027634","cliId":"","pno":2078836276,"cno":"","email":"DUNSTANGAL@AOL.COM","ename":"","eno":"","pphy":"MCKENNEY, BRANDY M","ppno":2078399101,"pcpadd":"Mercy Gorham Crossing Primary Care,19 S Gorham Crossing","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE GORHAM","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 DUNSTAN LANDING RD","madd2":"","madd3":"","mcity":"Scarborough","mstate":"ME","mzip":"04074","pcpfaxno":2078399201,"pcpnpi":1659458511,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7H68KV4MW32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","R059","R062","D3131","Z0101","H26492","J329","J339","J40","J328","J438","E785","Z0000","R0602","J069","Z8709","Z87891","H903","J439","K219","Z7189","H16223","H53002","H02401","H2512","R918","D171","R9720","M47816","R490","J330","Z0001","H05011","H31093","H53012","G4733","L03213","Q103","Q129","Q100","Z961","Q120","Z09","K0889","H5711","H5789","H5462","H0520","M79661","M5441","M25561","M25461","M1711","M779","S86911A"],"date":["2023-10-25","2023-03-17","2023-03-17","2023-11-20","2025-04-08","2023-11-20","2023-06-20","2023-01-24","2023-12-19","2023-12-19","2023-12-19","2023-06-09","2024-12-17","2023-03-17","2023-02-21","2023-03-03","2023-03-03","2024-11-06","2023-06-08","2023-10-24","2023-06-08","2023-11-20","2023-11-20","2023-11-20","2025-04-08","2023-03-17","2023-03-17","2023-11-07","2023-10-25","2023-10-24","2023-06-20","2023-12-12","2022-09-28","2022-09-13","2022-09-13","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-10","2022-08-10","2022-08-10","2022-08-12","2022-08-12","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-06-13"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","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":""}]}]}