{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas W Clarke","gend":0,"currentgend":"","add":"515 SPRING ST","city":"Westbrook","state":"ME","zip":"04092","dob":"1949-05-31","age":"","mstatus":"","insh":"10000033986","cliId":"","pno":2078544956,"cno":"","email":"","ename":"","eno":"","pphy":"HA NGOC, TIN","ppno":2078392559,"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":"515 SPRING ST","madd2":"","madd3":"","mcity":"Westbrook","mstate":"ME","mzip":"04092","pcpfaxno":2078287850,"pcpnpi":1073877791,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2PN4WR2FV84","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":["M1612","M6281","I4891","Z7901","S82892F","S82892E","S82832A","S9305XA","R7301","M109","S82832D","E119","S79912A","S8992XA","G8918","S82892C","E785","G4730","G4733","A000","I10","E669","K5520","Z1211","K5730","S93432A","W19XXXA","H401131","S82842B","Z23","R5383","H47233","S99912A","G4719","G4761","E6689","Z125","E668","S8262XD","E538","Z13228","Z136","Z711","W57XXXA","Z13220","M25552","S20362A","S20462A","R6889"],"date":["2022-11-28","2022-11-28","2025-06-12","2025-06-12","2025-10-02","2025-10-02","2024-01-13","2024-01-13","2022-11-28","2022-11-28","2025-10-02","2025-09-19","2024-01-14","2024-01-13","2024-01-13","2024-02-26","2024-12-09","2024-01-13","2025-08-05","2024-01-22","2025-09-19","2024-01-15","2023-05-18","2023-05-18","2023-05-18","2024-01-15","2024-01-15","2025-10-29","2024-01-13","2023-12-26","2024-12-09","2025-07-10","2024-01-13","2024-12-31","2024-12-31","2024-12-31","2024-12-09","2023-11-21","2024-02-05","2024-12-09","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2022-10-10","2022-10-18","2022-10-18","2022-08-19"],"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":[["","","ALLOPURINOL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","OLMESARTAN MEDOXOMIL","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FREESTYLE FREEDOM LITE","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","AMOXICILLIN","","","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":""}]}]}