{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Reynard S Gilbert","gend":0,"currentgend":"","add":"454 UPPER ST","city":"Turner","state":"ME","zip":"04282","dob":"1945-03-18","age":"","mstatus":"","insh":"10000032797","cliId":"","pno":2072253927,"cno":"","email":"","ename":"","eno":"","pphy":"RIVARD, GARY S","ppno":2075243501,"pcpadd":"180 CHURCH HILL RD,STE 1","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"454 UPPER ST","madd2":"","madd3":"","mcity":"Turner","mstate":"ME","mzip":"04282","pcpfaxno":2076476015,"pcpnpi":1194801993,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3RU9VK9EQ26","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","D509","R0602","I2510","E119","Z48812","J90","J9811","I509","J811","D649","I5042","I5040","E785","E1165","I10","I214","I2111","I4820","H35372","I442","I25810","J984","I469","E1129","Z0389","I340","R079","Z23","I484","I5020","I4891","Z0189","I351","I440","N1831","I4892","I429","Z951","I97121","I5A","N400","R7889","K5900","Q999","Z01810","I447","I499","R0600","N289","N189","I5022","J9601","Z09","I483","R771","R772","I255","I4901","R918","M9901","M4722","G44209","M9902"],"date":["2025-11-03","2025-10-20","2025-05-28","2025-11-05","2025-10-29","2025-03-25","2025-05-28","2025-05-28","2025-11-05","2025-05-28","2025-07-22","2025-07-22","2025-05-19","2023-05-01","2023-08-09","2025-01-27","2025-06-13","2025-01-27","2025-08-29","2024-11-20","2025-01-27","2025-02-21","2025-01-30","2025-01-31","2023-01-24","2025-01-24","2025-10-01","2025-01-27","2025-10-29","2025-03-14","2025-05-28","2025-10-06","2025-01-28","2025-01-28","2025-01-28","2025-10-29","2025-02-05","2025-05-19","2025-02-04","2025-02-04","2025-01-27","2025-01-27","2024-10-29","2024-10-29","2025-09-05","2025-01-28","2025-06-30","2025-06-30","2025-02-28","2025-09-18","2025-09-18","2025-03-04","2025-01-29","2025-02-28","2025-05-30","2025-08-15","2025-08-15","2025-05-30","2025-03-14","2025-01-28","2022-10-26","2022-10-26","2022-10-26","2022-10-26"],"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":[["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","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":""}]}]}