{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ronald B Estey","gend":0,"currentgend":"","add":"251 GAMAGE AVE","city":"Auburn","state":"ME","zip":"04210","dob":"1953-07-16","age":"","mstatus":"","insh":"10000037737","cliId":"","pno":2076898244,"cno":"","email":"popoluphagus@gmail.com","ename":"","eno":"","pphy":"PICKER, BETHANY J","ppno":2077952800,"pcpadd":"272 CONGRESS ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41013637","pcpcounty":"","pcpid":"","pcpname":"CMMC FAMILY MEDICINE RESIDENCY PROGRAM","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"251 GAMAGE AVE","madd2":"","madd3":"","mcity":"Auburn","mstate":"ME","mzip":"04210","pcpfaxno":2077744625,"pcpnpi":1407952468,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2V70XQ7EU31","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G9782","N1830","I6522","G4730","E785","E669","M9903","M5126","M5432","M5136","E1122","N184","R0609","I2510","R600","I6523","N1832","N179","H40023","I6389","R809","I10","G4733","I499","E119","Z0000","R339","R531","N1831","N051","M7989","R29898","E782","R200","I509","H6123","R9720","E781","I4510","E8779","R918","J309","R0600","J90","I129","J329","B9689","Z98890","R221","R059","N049","N031","R6889","J342","J343","J3489","R197","U071","I440"],"date":["2024-10-16","2024-06-24","2025-11-13","2024-10-14","2024-10-14","2024-10-14","2023-09-28","2023-09-28","2023-09-28","2023-09-28","2025-11-11","2025-07-31","2025-10-03","2025-07-09","2024-11-16","2024-10-16","2025-11-11","2024-11-19","2024-12-16","2024-10-16","2025-05-22","2025-11-11","2025-10-03","2024-10-14","2024-12-16","2025-08-08","2025-03-11","2024-10-13","2024-10-13","2023-12-20","2024-09-18","2024-10-14","2025-08-08","2024-10-17","2025-11-11","2025-08-12","2025-03-11","2022-12-13","2024-11-20","2024-11-15","2024-11-15","2024-07-24","2025-02-28","2024-11-18","2024-06-10","2025-06-14","2025-06-14","2025-11-13","2024-10-16","2025-06-14","2024-11-22","2022-11-07","2022-09-28","2022-09-14","2022-09-14","2022-09-14","2022-08-20","2022-08-20","2022-08-20"],"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":[["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","OLMESARTAN MEDOXOMIL","","","Select","Select",""],["","","OMEGA-3 ACID ETHYL ESTERS","","","Select","Select",""],["","","FLUTICASONE-VILANTEROL","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","KERENDIA","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","MUPIROCIN","","","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":{"indx":[["","","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}