{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Danny R Ammons","gend":0,"currentgend":"","add":"3 PORTER ST","city":"Augusta","state":"ME","zip":"04330","dob":"1949-05-01","age":"","mstatus":"","insh":"10000033749","cliId":"","pno":2076229859,"cno":"","email":"","ename":"","eno":"","pphy":"MCDONALD, JULIA","ppno":2076261561,"pcpadd":"Maine Dartmouth Family Medicine,149 North St Dept Family Med","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 PORTER ST","madd2":"","madd3":"","mcity":"Augusta","mstate":"ME","mzip":"04330","pcpfaxno":2076261902,"pcpnpi":1477849073,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8K89FA7RD48","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I739","N401","I771","I6523","Z08","N400","R0602","Z85118","J929","I2510","R0600","L89151","Z0100","Z23","C3490","K449","R7303","M109","J439","R030","F1090","J069","J90","I70213","R3912","Z87891","R918","R059","E039","M159","I70211","I708","I7133","I701","N3281","L98421","C3492","Z0000","E785","Z85828","R3915","U071","M5450","R000","Z95828","R600","Z955","Z79899","N189","M79662","M79661","R339","R911","Z579","L98429","Z20822","R350","N3943","Z902","M4800","J984","R5383","N3941","R062","J9811"],"date":["2025-11-05","2025-01-21","2024-09-24","2024-04-23","2025-01-28","2024-01-03","2024-07-08","2025-02-26","2024-11-30","2025-01-23","2025-03-19","2025-05-20","2024-11-18","2025-09-15","2024-07-05","2023-02-09","2023-09-22","2023-09-22","2024-07-05","2025-08-25","2025-08-25","2024-11-29","2025-03-03","2025-05-01","2024-02-13","2024-12-17","2025-03-03","2024-11-30","2023-10-18","2023-10-10","2024-09-24","2024-09-24","2023-07-06","2023-07-06","2025-05-06","2025-05-08","2023-07-10","2025-08-20","2023-10-18","2023-10-18","2024-03-11","2025-03-05","2022-11-28","2022-11-28","2023-05-16","2024-08-06","2024-08-06","2025-03-19","2025-01-02","2023-02-06","2023-02-06","2024-12-17","2025-01-23","2025-03-19","2025-05-20","2022-11-28","2024-01-05","2024-01-05","2022-12-01","2023-07-14","2023-02-14","2023-02-14","2024-09-17","2022-11-21","2022-10-27"],"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":[["","","CELECOXIB","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","CILOSTAZOL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","EZETIMIBE","","","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":""}]}]}