{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Harvey I Bell","gend":0,"currentgend":"","add":"38 BOWDOINHAM RD","city":"Lisbon Falls","state":"ME","zip":"04252","dob":"1949-03-07","age":"","mstatus":"","insh":"10000032571","cliId":"","pno":2074074201,"cno":2075775938,"email":"Tritona3@twc.com","ename":"","eno":"","pphy":"BEGGS, ALEX W","ppno":2077955700,"pcpadd":"12 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407676","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"38 BOWDOINHAM RD","madd2":"","madd3":"","mcity":"Lisbon Falls","mstate":"ME","mzip":"04252","pcpfaxno":2077955727,"pcpnpi":1750862769,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6HW1JP5FC27","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1211","M19011","F4322","Z96612","M9903","M5450","M9901","M542","M25462","Z96652","I480","I2510","F419","R399","I4891","H40053","R319","G4700","R0981","F40243","L304","L814","L821","K8020","H3562","Z0000","I4819","Z5181","L570","X32XXXA","Z471","K5900","E7800","J302","B349","L298","N200","C61","I452","R9431","K7689","N281","M65341","R002","D3132","R6889","Z96653","M25461","Q615","R300","I4892","N201","M8589","I440","M79671","R809","M25511","I4510","Z8546","K625","M25522","M25422","M7022","I499","L0292","M8580","I10","R109","F4521","J3081","J301","J3089","D120","K5730","K648","E213","N2581","Z09","R001","L400","B356","H31103","R195","R000","M25519","L309","R9341","R42","N3281","R059","Z79899","G8918","M19012","J449","E785","M75102","Z96619","R739","Z01818","Z01810","I471","I4820","D1801"],"date":["2025-05-15","2025-10-16","2025-06-17","2025-10-16","2025-03-12","2025-03-12","2025-03-12","2025-03-12","2025-05-29","2024-05-29","2025-06-16","2025-05-28","2025-01-25","2025-10-21","2025-02-21","2025-05-19","2025-06-09","2023-01-03","2023-01-03","2023-01-03","2025-10-17","2025-10-17","2025-10-17","2025-07-02","2024-07-25","2024-05-09","2025-10-13","2025-10-13","2023-10-04","2023-10-04","2025-05-29","2023-05-16","2023-11-16","2023-05-16","2025-01-23","2023-10-04","2025-07-02","2024-07-08","2025-02-10","2025-02-10","2023-11-02","2023-11-02","2024-02-07","2025-06-16","2025-04-04","2023-01-01","2025-05-29","2025-05-29","2025-01-28","2025-06-08","2024-05-23","2025-06-09","2023-12-27","2024-05-21","2024-07-19","2024-12-05","2024-04-30","2025-01-24","2025-01-23","2025-05-05","2025-07-14","2025-07-14","2025-07-14","2025-04-01","2024-09-16","2024-05-09","2024-05-09","2025-05-21","2025-06-17","2025-10-23","2025-10-23","2025-10-23","2025-05-15","2025-05-15","2025-05-15","2024-03-17","2024-03-19","2025-10-13","2025-01-24","2025-01-15","2024-02-27","2023-03-24","2025-01-22","2025-01-22","2024-04-30","2025-04-08","2023-07-11","2025-02-01","2024-07-08","2023-04-30","2024-06-28","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-11-10","2022-10-03","2022-10-03","2022-09-16","2022-09-22","2022-09-10","2022-08-25"],"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",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","ALFUZOSIN HCL ER","","","Select","Select",""],["","","DOFETILIDE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ZORYVE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","DILT-XR","","","Select","Select",""],["","","DILTIAZEM 24HR ER (XR)","","","Select","Select",""],["","","CARTIA XT","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","RAMELTEON","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","HYDROXYZINE HCL","","","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":""}]}]}