{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard K Brautigam","gend":0,"currentgend":"","add":"25 THORNTON WAY APT 314","city":"Brunswick","state":"ME","zip":"04011","dob":"1931-09-09","age":"","mstatus":"","insh":"10000028958","cliId":"","pno":2074085974,"cno":"","email":"rkbraut@gmail.com","ename":"","eno":"","pphy":"GARDINER, PAMELA A","ppno":2077984050,"pcpadd":"Martins Point Healthcare,74 Baribeau Dr","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 THORNTON WAY APT 314","madd2":"","madd3":"","mcity":"Brunswick","mstate":"ME","mzip":"04011","pcpfaxno":2078287850,"pcpnpi":1023030020,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4EE6T61TM81","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H6123","M9905","M25511","R2689","I77819","I471","I10","M19012","M19011","M75102","M75101","N529","N401","M25551","R918","Z0000","N5201","M79631","M25512","Z23","K420","D7589","Z96641","M5116","R634","M1811","M549","I4710","I351","R053","S4991XA","Z136","Z13220","Z96643","N189","M79644","R9720","Z4802","R6889","R0981","H6121","H6122","I499","I6523","H35373","H903","N400","Z1211","H26492","H40053","R3912","N1830","M79641","H26491","R519","H527","F4321","I4729","R911","K7689","J929","I2510","J8410","R590","R002","Z0101","R0989","E785","F419","R4182","S6991XA","R4189","K56609","K5730","K429","N289","D122","Z86010"],"date":["2024-04-02","2025-07-09","2025-07-09","2025-07-09","2023-01-30","2023-09-19","2025-05-21","2025-11-05","2025-11-05","2025-11-05","2025-11-05","2025-10-28","2025-10-28","2024-11-22","2023-02-10","2023-05-05","2024-11-21","2024-05-17","2024-09-26","2023-11-20","2023-04-15","2023-05-09","2024-11-22","2024-11-23","2023-07-26","2025-04-23","2024-01-05","2024-01-30","2023-01-30","2023-01-20","2024-11-13","2025-05-21","2025-05-21","2024-11-22","2025-04-28","2024-10-17","2023-03-30","2025-04-26","2023-03-17","2024-03-19","2024-03-19","2024-03-19","2023-04-05","2025-11-06","2025-09-22","2025-09-24","2024-11-21","2023-05-16","2023-06-28","2025-09-22","2024-11-21","2024-04-08","2024-11-04","2025-09-22","2024-12-03","2025-09-22","2023-05-05","2023-05-12","2023-05-11","2023-05-11","2023-05-11","2023-05-11","2023-02-10","2023-02-10","2022-12-23","2025-09-19","2025-11-06","2023-04-15","2023-04-15","2023-04-15","2024-11-04","2025-10-22","2023-04-15","2023-04-15","2023-04-15","2025-10-22","2022-09-19","2022-09-19"],"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":[["","","TRAZODONE HCL","","","Select","Select",""],["","","ALFUZOSIN HCL ER","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","TERAZOSIN HCL","","","Select","Select",""],["","","CARTIA XT","","","Select","Select",""],["","","CAPVAXIVE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","M-M-R II VACCINE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","ABRYSVO","","","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":""}]}]}