{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leonard W Russell","gend":0,"currentgend":"","add":"4A CARYN DR","city":"Saco","state":"ME","zip":"04072","dob":"1945-01-06","age":"","mstatus":"","insh":"10000027671","cliId":"","pno":2073183479,"cno":"","email":"lenruss16@yahoo.com","ename":"","eno":"","pphy":"BELCHER, MATTHEW","ppno":2078282402,"pcpadd":"100 GANNETT DRIVE,SUITE C","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4A CARYN DR","madd2":"","madd3":"","mcity":"Saco","mstate":"ME","mzip":"04072","pcpfaxno":2078282425,"pcpnpi":1952351223,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1P43C03TP74","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T8484XA","C61","G4733","R2681","Z96651","H8112","H8111","Z23","R0602","R1310","M25562","K449","I2510","I480","I10","I071","E785","E559","N189","S0990XA","I4891","M79662","I959","R42","Z131","E039","Z13220","Z01818","M1712","S52515D","Z5111","R051","R531","H26491","R530","Z9181","N1831","N390","H35033","H90A31","H90A22","Z96652","M1711","I4811","R0609","E782","S52515A","R6889","S6992XA","S52502A","Z471","R002","Z136","I493","I4710","I498","G7281","Z7901","E7800","M7989","C775","K222","M25561","S52592D","K200","R197","Z0000","M2392","S76112A","K219","R059","R5381","K2289","M5450","M170","R6883","N3000","I129","E030","D649","R262","L270","G8918","H9191","H8301","H53141","Z0101","Z08","Z8546","Z923","A4151","G4730","F32A","S76112D","I082","Z736","J0110","Z03818","R0981","J40","H903","H9193","T304","T25412A","T25222A","T25212A","M1A0790","H04123","Z951","U071","I471","R7989","J90","I4892","I083","Z954","I50810","I700","I081","Z79899","R0600","Z48812","I25810","R5383"],"date":["2025-02-08","2025-08-28","2025-07-25","2025-07-31","2025-07-31","2025-07-31","2025-07-31","2025-11-12","2025-04-18","2024-02-29","2025-03-31","2024-05-15","2025-06-05","2025-11-06","2025-06-05","2023-09-13","2024-02-29","2024-02-20","2025-06-05","2025-02-08","2025-11-14","2025-02-08","2025-02-08","2024-08-26","2024-07-10","2025-08-26","2024-07-10","2025-01-18","2025-02-05","2025-09-17","2025-08-28","2025-04-15","2025-11-07","2024-01-31","2024-08-26","2024-08-26","2024-09-18","2025-04-02","2024-01-31","2025-10-16","2025-10-16","2025-05-15","2024-06-18","2025-07-25","2023-09-27","2025-07-25","2025-08-20","2023-12-28","2025-08-20","2025-08-20","2025-05-15","2023-09-27","2023-09-27","2025-09-19","2025-09-19","2025-09-19","2025-04-30","2025-04-10","2025-04-07","2025-08-20","2023-03-01","2024-05-15","2024-06-18","2025-08-29","2024-05-15","2025-04-18","2025-08-01","2024-09-04","2024-09-04","2024-02-29","2025-04-18","2025-04-18","2024-02-29","2025-08-06","2025-02-14","2025-04-22","2025-04-22","2024-09-18","2023-07-24","2023-07-24","2025-04-30","2025-04-10","2025-02-05","2025-09-27","2025-09-27","2024-01-18","2025-09-15","2023-01-27","2023-01-27","2023-01-27","2025-04-30","2024-05-15","2024-05-15","2024-10-16","2023-09-08","2025-04-30","2023-04-20","2025-04-15","2025-04-15","2025-04-15","2022-10-14","2022-09-23","2022-08-08","2022-07-27","2022-07-24","2022-07-23","2022-08-02","2022-06-30","2022-06-01","2022-05-10","2022-03-21","2022-02-23","2021-10-13","2021-10-15","2021-10-14","2021-10-14","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-12-30","2021-10-03","2022-02-22","2022-02-22"],"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":[["","","TRAMADOL HCL","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ORGOVYX","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","VANCOMYCIN HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","TERAZOSIN HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","AMIODARONE HCL","","","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":""}]}]}