{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roger A Dupre","gend":0,"currentgend":"","add":"26 RACHEL BLVD","city":"Lewiston","state":"ME","zip":"04240","dob":"1942-01-06","age":"","mstatus":"","insh":"10000029397","cliId":"","pno":2077828419,"cno":"","email":"ropo564@yahoo.com","ename":"","eno":"","pphy":"DUQUETTE, ADAM","ppno":2077847388,"pcpadd":"190 STETSON RD,","pcpcity":"AUBURN","pcpstate":"ME","pcpzip":"42107813","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"26 RACHEL BLVD","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":2077952043,"pcpnpi":1679884522,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3C44CX3KP03","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R195","D124","D125","Z95810","M75101","B078","R208","L570","X32XXXA","L821","L814","Z08","Z85820","C44519","C44311","D485","C44319","M25511","M25611","M6281","Z09","E041","E069","H2512","H2511","I509","E1122","H5703","I4891","Z0000","I10","N529","R059","D034","I428","Z7901","R519","S0990XA","M542","S199XXA","J209","M75121","S43431A","M25411","I351","I429","E785","I5020","C44622","D2361","E042","E119","E118","S0093XA","W009XXA","I517","H2513","H43813","R6889","I130","N1831","Z7984","M25512","R531","X500XXA","I447","R319","C61"],"date":["2023-03-20","2023-03-20","2023-03-20","2025-09-09","2023-04-03","2025-06-10","2025-06-10","2025-06-10","2025-06-10","2025-06-10","2025-06-10","2025-06-10","2025-06-10","2024-12-05","2024-06-13","2024-12-05","2023-11-29","2023-03-30","2023-03-30","2023-03-30","2025-09-08","2025-08-13","2025-07-30","2024-02-27","2024-02-13","2024-07-31","2025-05-30","2024-02-27","2025-05-23","2025-02-18","2025-05-30","2025-01-08","2025-01-08","2023-12-22","2025-09-04","2023-03-13","2024-12-18","2024-12-18","2024-12-18","2024-12-18","2025-04-27","2023-02-10","2023-02-10","2023-02-10","2024-06-11","2024-06-11","2024-02-13","2023-04-04","2023-01-31","2023-01-31","2025-02-19","2025-10-07","2024-02-13","2024-12-18","2024-12-18","2023-04-04","2023-12-21","2023-12-21","2023-05-11","2023-02-02","2023-02-02","2023-02-02","2022-11-08","2022-11-08","2022-11-08","2022-10-12","2022-08-22","2022-08-22"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TERAZOSIN HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","IMIQUIMOD","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y 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":{"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":""}]}]}