{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raymond G Strout","gend":0,"currentgend":"","add":"12 Birch Dr","city":"Standish","state":"ME","zip":"04084","dob":"1949-08-09","age":"","mstatus":"","insh":"10000035357","cliId":"","pno":2076484295,"cno":2072720718,"email":"declined@091422.com","ename":"","eno":"","pphy":"CHASE, SCOTT M","ppno":"","pcpadd":"582 ROOSEVELT TRAIL,","pcpcity":"WINDHAM","pcpstate":"ME","pcpzip":"04062","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 Birch Dr","madd2":"","madd3":"","mcity":"Standish","mstate":"ME","mzip":"04084","pcpfaxno":"","pcpnpi":1760584007,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6KF9RR7AQ55","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1152","G3183","F02818","L84","L851","E1159","M79671","M79672","E1165","D649","Z794","E1100","E039","L602","R2689","E1151","G20","R531","R627","F0390","F03918","I10","E785","L853","L300","U071","A000","B356","M2392","E119","Z87891","S0990XA","S199XXA","F5101","R000","K219","R262","R4182","Z743","F3189","K5900","R509","Z96652","R404","F319","G20A1","R21","M720","K861","M25562","Z23","Z66","B351","M79674","M79675","I7091","R195","Z7189","N1831","I739","J61","C61","F1021","S8992XA","N481","I499","G309","R059","F0150","F0280","J069","F3175","G3189","J310","N179","Z0000","E8342","F0391","F0281","R7889","R2242","J948","R9431","E1149","E162","W19XXXA","H35423","E113293","F329","F419","M2041","M2042","G629","E1122"],"date":["2024-07-31","2024-12-18","2023-01-10","2025-08-05","2023-12-20","2025-08-28","2023-12-20","2023-12-20","2024-03-21","2024-02-01","2024-03-21","2025-11-04","2025-11-04","2025-03-31","2025-03-31","2025-03-31","2023-07-21","2023-01-10","2023-01-10","2023-07-11","2023-01-10","2025-08-05","2022-12-23","2024-04-30","2025-07-28","2024-08-20","2023-01-18","2023-03-30","2023-07-10","2023-07-10","2023-07-10","2025-11-05","2025-11-05","2023-01-20","2023-02-10","2024-07-31","2023-09-26","2025-11-06","2023-07-11","2025-08-25","2023-01-05","2025-10-17","2023-07-13","2024-10-09","2024-12-18","2024-12-18","2025-08-05","2023-08-10","2023-06-15","2023-07-10","2023-01-06","2023-01-06","2023-10-18","2023-10-18","2023-10-18","2023-10-18","2024-03-21","2023-01-19","2023-01-19","2023-12-20","2023-10-17","2023-10-17","2024-12-18","2023-07-10","2023-03-14","2025-10-17","2025-01-22","2025-10-17","2024-09-09","2024-09-09","2025-10-17","2025-08-28","2024-09-26","2024-03-21","2022-11-11","2022-11-22","2022-10-14","2022-09-30","2022-09-23","2022-09-19","2022-09-19","2022-09-19","2022-09-07","2022-08-23","2022-09-06","2022-09-06","2022-08-25","2022-08-25","2022-07-29","2022-07-29","2022-05-31","2022-05-31","2022-07-27","2022-04-12"],"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":[["","","BUSPIRONE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","SAFETYGLIDE INSULIN SYRINGE","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","LANTUS","","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","RAMELTEON","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}