{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leone C Forsythe","gend":1,"currentgend":"","add":"22 KENNEY DR","city":"Bucksport","state":"ME","zip":"04416","dob":"1937-06-14","age":"","mstatus":"","insh":"10000037742","cliId":"","pno":2076924813,"cno":"","email":"Declined@03092020.com","ename":"","eno":"","pphy":"PARADIS, KENDRA M","ppno":"","pcpadd":"C\/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT,PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"22 KENNEY DR","madd2":"","madd3":"","mcity":"Bucksport","mstate":"ME","mzip":"04416","pcpfaxno":2077774397,"pcpnpi":1588012314,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8XX0DA9EH13","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G9341","R4182","Z743","A419","M6281","R278","R2689","Z9181","R42","N390","M25551","W19XXXA","R0602","J984","I672","S2231XA","L821","Z0000","I10","E119","F01A0","Z09","F0150","L820","J189","N3000","I951","H40022","H401112","H53461","I639","Z0101","H5203","H52223","H524","H353112","E1129","E782","R112","S299XXA","F0390","G9389","R531","F03B0","Z8673","K8020","K5730","N83202","R55","S2241XD","I517","R918","S2241XA","W1830XA","E1122","S0990XA","R410","J690","Z23"],"date":["2025-07-01","2025-06-27","2025-06-27","2025-06-16","2022-12-28","2022-12-28","2022-12-28","2025-06-17","2023-08-08","2025-06-27","2025-06-20","2025-06-20","2025-06-27","2023-01-06","2025-08-01","2025-06-17","2024-04-26","2025-04-30","2023-03-31","2023-04-21","2023-02-06","2023-02-10","2023-01-18","2024-05-06","2025-06-27","2024-07-12","2023-03-31","2024-12-11","2024-12-11","2024-12-11","2022-11-11","2023-04-21","2024-06-03","2024-06-03","2024-06-03","2023-04-21","2024-04-26","2024-05-06","2025-07-01","2025-07-01","2025-06-27","2023-08-02","2023-01-06","2023-01-02","2023-08-02","2023-01-06","2023-01-06","2023-01-06","2023-08-04","2025-06-18","2025-07-11","2023-01-02","2025-06-16","2025-06-16","2025-04-30","2023-01-02","2023-01-06","2023-01-06","2022-10-28"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","NIFEDIPINE ER","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","BIMATOPROST","","","Select","Select",""],["","","TRAVOPROST","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CONTOUR NEXT TEST STRIP","","","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":""}]}]}