{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kenneth R Shea","gend":0,"currentgend":"","add":"18 SUNSET PARK RD","city":"ELLSWORTH","state":"ME","zip":"04605","dob":"1943-06-12","age":"","mstatus":"","insh":"10000038309","cliId":"","pno":2076672904,"cno":"","email":"kshea@myfairpoint.net","ename":"","eno":"","pphy":"NIGHTINGALE, STEPHEN H","ppno":2074697371,"pcpadd":"33 Seaveys Way Ste 2,","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"BUCKSPORT REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 SUNSET PARK RD","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2074697306,"pcpnpi":1538140520,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8FA0WP5VV25","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1212","Z1211","L0390","L03115","E782","I8000","E118","I8001","R7989","Z4502","B351","D6859","E038","J984","Z862","J4540","H401233","H04123","Z7952","Z961","R300","I480","I483","I129","N182","I8002","G5602","E119","K529","R7401","M2030","S90416A","M79671","H02403","Z23","R195","D122","D125","I509","R0602","L89892","R1110","N400","R739","I4891","I4720","I498","I5021","J189","I82811","D869","H52223","H353131","Z0000","R600","M542","L89899","I5032","K2970","M2031","K759","I429","I2510","Z950","I4892","I081","Z8679","K769","Z8701","N281","R918","R059","D489","H35371","H43391","H35443","H35441","I517","Q6671","M79672","I110","I950","R945","Z98890","D862","M7989","L602","R110","R10817","R0902","R0600","H47021","Z79899"],"date":["2024-12-31","2025-01-23","2024-10-09","2024-10-22","2024-12-27","2025-06-24","2025-09-03","2024-10-25","2025-09-03","2025-09-10","2024-09-16","2025-04-03","2022-11-30","2023-12-22","2023-12-22","2023-12-22","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2025-01-20","2023-07-20","2022-10-26","2022-10-18","2022-10-18","2024-11-26","2024-09-25","2025-09-02","2024-10-13","2025-06-11","2025-02-10","2025-02-10","2025-02-10","2024-06-18","2022-10-05","2025-01-23","2025-01-23","2025-01-23","2024-10-04","2024-10-04","2025-04-10","2024-10-04","2025-01-03","2025-01-03","2023-08-31","2023-08-31","2023-08-31","2022-12-04","2025-02-26","2024-10-15","2024-10-13","2024-10-10","2024-10-10","2024-12-09","2024-10-18","2024-08-13","2025-07-08","2023-08-29","2025-05-02","2025-07-08","2025-04-15","2023-05-12","2023-06-30","2023-05-12","2023-05-25","2025-08-19","2025-08-19","2025-05-02","2022-10-28","2025-01-29","2025-02-26","2025-02-26","2024-01-15","2023-02-21","2023-02-21","2023-02-21","2023-02-21","2025-02-26","2023-04-05","2024-09-16","2023-05-25","2022-10-26","2025-01-29","2022-10-26","2023-06-30","2024-10-10","2024-09-16","2024-10-05","2024-10-05","2022-09-26","2022-09-09","2022-08-10","2022-08-10"],"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":[["","","LATANOPROST","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POT ER","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","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":""}]}]}