{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert T Thayer","gend":0,"currentgend":"","add":"40 FICKETT ST","city":"South Portland","state":"ME","zip":"04106","dob":"1946-02-08","age":"","mstatus":"","insh":"10000028568","cliId":"","pno":2075360851,"cno":2073295245,"email":"decline10152024@gmail.com","ename":"","eno":"","pphy":"DEGRINNEY, JOSEPH T","ppno":2078833491,"pcpadd":"301 US ROUTE 1,BUILDING C","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40747609","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"40 FICKETT ST","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":2073968632,"pcpnpi":1538106679,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4F71CR0NE19","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C670","Z466","C679","D090","Z9079","I10","E785","K219","Z713","N1832","I151","N2581","Z905","E782","Z8554","N189","M1712","M25511","M19011","M25562","R7303","F411","R4182","Z8546","M109","R8289","Z8551","D303","M75122","M25512","D414","C495","N401","R531","C689","M6281","R293","S46011D","M19012","M67814","M654","Z923","M75121","G5601","M79674","T63441A","S46012A","R399","M25612","H2513","H348322","R350","N393","M25571","Z85528","N3080","S46011A","I129","C669","R6889","M7551","M7552","D631","R202","M65322","N3289","M79671","E873","R82998","K8020","K762"],"date":["2025-09-18","2024-03-12","2025-09-11","2024-07-15","2025-08-15","2023-12-06","2024-12-13","2024-12-13","2023-04-24","2025-09-22","2025-04-23","2024-12-09","2023-07-06","2024-09-26","2023-12-19","2025-11-13","2025-10-13","2025-07-24","2025-03-03","2025-10-13","2023-07-18","2024-03-04","2024-12-13","2023-12-06","2025-11-13","2024-12-13","2025-08-15","2024-12-13","2025-08-05","2025-08-05","2024-12-13","2023-06-21","2023-06-21","2025-07-24","2023-06-21","2025-05-28","2025-05-28","2025-05-28","2025-07-30","2025-07-30","2025-08-01","2025-08-15","2025-03-03","2025-03-17","2025-04-25","2024-07-14","2025-10-13","2024-08-02","2025-04-22","2023-02-16","2023-02-16","2024-08-22","2024-08-22","2025-04-20","2023-07-06","2022-11-28","2025-03-24","2022-11-28","2023-03-14","2023-01-01","2024-09-24","2024-09-24","2022-12-01","2024-05-16","2024-05-16","2024-07-15","2025-05-01","2022-12-01","2022-10-31","2022-09-22","2022-09-22"],"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":[["","","ALLOPURINOL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUCELVAX QUAD 2022-2023","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}