{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Howard C Wadleigh","gend":0,"currentgend":"","add":"1099 MANCHESTER RD","city":"Belgrade","state":"ME","zip":"04917","dob":"1943-03-23","age":"","mstatus":"","insh":"10000032264","cliId":"","pno":2074953523,"cno":"","email":"declined@092425.com","ename":"","eno":"","pphy":"PRESTON, DAVID G","ppno":2078731098,"pcpadd":"Mid Maine Medicine,325B Kennedy Memorial Dr","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"THAYER INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1099 MANCHESTER RD","madd2":"","madd3":"","mcity":"Belgrade","mstate":"ME","mzip":"04917","pcpfaxno":2078735461,"pcpnpi":1871559203,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8EN5AP3VF73","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H2511","N189","H2512","I129","E1122","N1832","R809","D649","D500","Z1283","K625","D62","Z872","E119","C44311","C44519","H401131","H019","N1830","H401132","M25561","M7989","M1711","H0289","H01111","I10","G4733","K5731","I130","I5020","I214","Z743","R0602","N281","N289","N401","F32A","Z794","H5213","H52203","H524","L309","E785","Z0001","R197","Z0000","H25093","L814","I2510","M25461","K922","C44319","D1801","L821","D485","K5730","N400","R109","K921","D239","H02834","Z600","L570","Z0101","L700","R112","I700","K8020","K828","N329","Z7984","J439","Z789","K5792","L905","I5A","I252","R600","A084","N179","D509","L820","M109","R7989","J9811","R911","I444","I4589","N529"],"date":["2024-12-02","2023-02-22","2024-12-02","2025-10-31","2025-07-17","2025-07-17","2023-12-04","2024-08-31","2025-11-11","2024-01-04","2025-10-10","2025-10-10","2022-12-19","2025-11-14","2025-04-29","2025-09-08","2025-10-23","2025-10-23","2023-02-16","2024-07-18","2024-12-05","2024-12-05","2024-12-05","2025-09-10","2025-07-23","2025-10-23","2023-01-06","2025-10-10","2024-04-20","2024-04-20","2024-04-02","2024-04-20","2024-04-01","2025-07-08","2025-07-08","2024-03-06","2024-08-26","2025-04-08","2024-05-07","2024-05-07","2024-05-07","2023-06-14","2025-07-17","2023-06-14","2025-06-23","2025-06-23","2023-01-19","2025-07-17","2025-10-10","2024-04-01","2024-10-24","2025-01-08","2025-07-17","2025-07-17","2025-01-08","2025-10-10","2024-10-24","2024-10-24","2025-10-10","2025-06-03","2025-06-03","2024-12-16","2025-09-10","2023-09-14","2025-07-17","2024-04-03","2024-04-03","2024-04-20","2024-04-20","2024-04-20","2025-04-15","2023-01-17","2025-10-10","2025-10-22","2025-09-08","2024-04-05","2024-04-01","2024-04-01","2024-04-05","2024-04-05","2023-02-17","2024-01-04","2025-03-24","2024-04-01","2024-04-01","2025-10-31","2024-04-03","2024-04-03","2022-10-10"],"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":[["","","LATANOPROST","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","TRUEPLUS LANCETS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}