{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gary K Hemenway","gend":0,"currentgend":"","add":"25 POND RIDGE DR","city":"LEWISTON","state":"ME","zip":"04240","dob":"1943-10-27","age":"","mstatus":"","insh":"10000030251","cliId":"","pno":2077832123,"cno":"","email":"","ename":"","eno":"","pphy":"TREMIS, MARIE ALEXANDRIA","ppno":2077955750,"pcpadd":"76 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2077836880,"add2":"","add3":"","madd1":"25 POND RIDGE DR","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":"","pcpnpi":1285110023,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5JG7F86DD36","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H3530","I4892","J0190","E785","D696","H938X9","K259","K2950","D485","L570","L821","L814","L820","R208","H2511","C44519","C44712","H2513","H3561","R002","R6889","H2512","H52222","H52221","D649","D122","D124","K640","M9901","M9902","M9904","M9906","E039","Z0000","M5432","J189","R509","R059","H9201","M79605","J069","R3911","K319"],"date":["2025-05-21","2024-07-26","2025-07-01","2024-08-27","2025-07-23","2024-12-30","2025-05-12","2025-05-12","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2024-12-31","2023-02-24","2023-02-24","2024-09-13","2024-03-05","2024-08-27","2023-05-19","2025-01-14","2025-01-14","2024-12-31","2025-03-13","2024-12-17","2024-12-17","2024-12-17","2024-06-10","2024-06-10","2024-06-10","2024-06-10","2023-07-25","2025-08-06","2024-06-10","2025-11-09","2025-11-09","2025-11-09","2025-10-07","2025-10-07","2025-03-03","2024-07-26","2025-03-13"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","TYPHIM VI","","","Select","Select",""],["","","ATOVAQUONE-PROGUANIL HCL","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","HAVRIX","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}