{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul D Doak","gend":0,"currentgend":"","add":"88 VERRILL RD","city":"POLAND","state":"ME","zip":"04274","dob":"1949-11-10","age":"","mstatus":"","insh":"10000037110","cliId":"","pno":2072401135,"cno":"","email":"pauldoak1949@gmail.com","ename":"","eno":"","pphy":"ALLEN, JOSHUA","ppno":"","pcpadd":"364 MAINE ST,","pcpcity":"POLAND","pcpstate":"ME","pcpzip":"42745109","pcpcounty":"","pcpid":"","pcpname":"POLAND COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"88 VERRILL RD","madd2":"","madd3":"","mcity":"POLAND","mstate":"ME","mzip":"04274","pcpfaxno":2079985756,"pcpnpi":1124686142,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3YH0XJ5GD37","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4719","K429","J449","Z0000","M9900","M9901","M9902","M9903","M5450","E785","I4710","I4891","R001","M542","Z7689","Z125","E781","M65331","M65351","M65341","L509","Z0101","I10","M109","Q2110","I358","I340","I4510","I639","G5601","G459","G453","G43109","L820","L2989","R208","S30860A","W57XXXA","Q2112","I5020","J45909","R0781","H5053","K436","I63233","R200","L570","D2239","L814","D225","L821","I499","R0789","R454","R52","Z5181","H04123","L500","Z7982","M65332","Z09","E782","M65342","K469","K439","R109","N400","M1990","R6889","D485","X32XXXA","R002","M9908","R079","R6884","N503","I861","Z8673","L738","H903","M65352","D2272","D2271","G8929"],"date":["2024-12-16","2024-03-27","2025-09-12","2025-08-28","2025-11-13","2025-11-13","2025-11-13","2025-11-13","2025-11-13","2025-03-06","2025-10-24","2024-03-27","2024-03-27","2023-06-20","2024-03-21","2024-05-23","2025-05-27","2025-03-21","2025-03-21","2024-12-20","2025-09-14","2024-12-23","2024-07-08","2024-07-08","2024-03-20","2024-03-20","2024-03-20","2024-03-18","2024-03-18","2023-01-09","2024-03-20","2024-03-18","2024-03-18","2025-06-13","2025-06-13","2025-09-08","2025-04-26","2025-04-26","2024-03-20","2024-03-20","2023-02-21","2025-09-10","2025-08-15","2024-03-13","2024-03-17","2024-03-17","2024-12-02","2024-12-02","2024-12-02","2024-12-02","2024-12-02","2025-10-28","2024-03-18","2025-01-14","2024-05-29","2025-10-28","2023-04-14","2025-09-12","2025-09-12","2024-11-05","2024-04-15","2024-04-18","2023-10-11","2024-01-16","2024-01-17","2024-01-16","2023-02-02","2023-02-02","2023-01-12","2023-10-25","2023-10-25","2024-03-15","2025-09-10","2023-12-27","2023-12-27","2024-10-09","2024-10-09","2024-08-08","2023-10-25","2023-08-07","2024-11-05","2022-11-21","2022-11-21","2022-10-04"],"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":[["","","REPATHA SURECLICK","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FLECAINIDE ACETATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","REPATHA SYRINGE","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","GEMFIBROZIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":""}]}]}