{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David O St Jean","gend":0,"currentgend":"","add":"512 RIDGE RD","city":"Bowdoinham","state":"ME","zip":"04008","dob":"1948-02-13","age":"","mstatus":"","insh":"10000032729","cliId":"","pno":2076663258,"cno":"","email":"","ename":"","eno":"","pphy":"DECK, MARCUS M","ppno":2077984400,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"512 RIDGE RD","madd2":"","madd3":"","mcity":"Bowdoinham","mstate":"ME","mzip":"04008","pcpfaxno":2077984018,"pcpnpi":1891717872,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4NC5HJ8VT54","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":["K317","K3189","R1031","R630","R9089","R270","I672","Z95818","I480","C679","I2510","Z905","N400","I7102","J311","K130","R8290","R109","R634","H532","Z8679","M65312","J449","F32A","E782","R4182","R942","K31A19","R55","F17210","J029","R0602","R42","L739","G5603","Z8551","J329","R918","J479","J432","N3289","Z23","L910","S0993XA","R001","G5601","J439","I358","R059","R531","F17200","J3489","F17219","L989","M79641","Z13228","I7121","I6523","K458","G8929","R269","G43909","Z85528","N189","K439","Z7901","F39","C641","I700","H6122","E785","F329","J387","J383","J3502","K1321"],"date":["2025-02-11","2025-02-11","2025-06-27","2024-08-05","2025-02-17","2024-09-22","2024-08-29","2025-09-02","2024-03-05","2024-01-05","2024-08-29","2025-03-03","2024-08-29","2024-08-29","2023-12-29","2023-12-29","2024-12-05","2025-01-21","2025-01-21","2025-01-21","2025-01-21","2024-09-06","2025-09-10","2025-02-11","2025-09-29","2025-02-11","2025-03-14","2025-02-11","2025-09-13","2025-09-10","2023-10-14","2025-02-17","2025-03-22","2024-01-22","2025-11-06","2024-01-05","2023-10-14","2025-03-03","2025-03-03","2024-03-03","2024-01-05","2025-10-03","2024-06-24","2025-02-17","2025-02-17","2024-04-26","2025-03-03","2025-02-17","2024-08-05","2024-08-05","2024-08-05","2023-05-17","2023-05-17","2023-06-21","2025-11-06","2025-09-29","2023-03-08","2025-09-13","2023-03-30","2025-06-27","2023-06-08","2023-06-08","2023-06-08","2023-03-13","2023-03-30","2023-03-13","2023-01-30","2023-01-30","2023-01-30","2025-04-04","2023-03-13","2023-03-13","2022-10-05","2022-08-25","2022-08-25","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":[["","","EZETIMIBE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","BEVESPI AEROSPHERE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DIVALPROEX SODIUM ER","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","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":""}]}]}