{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gilbert H Page","gend":0,"currentgend":"","add":"4 L ST","city":"BANGOR","state":"ME","zip":"04401","dob":"1937-10-30","age":"","mstatus":"","insh":"10000038512","cliId":"","pno":2073853046,"cno":2073853046,"email":"gilpage34@gmail.com","ename":"","eno":"","pphy":"LANGLEY, AMY A","ppno":"","pcpadd":"PO BOX 1599,","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"BREWER MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4 L ST","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":2079470435,"pcpnpi":1083906622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3GN8KP7XA29","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I5032","E119","S82832A","I081","I2720","I77810","I4821","Z0101","H5203","H52223","H524","R079","I480","S82432D","I4891","X58XXXD","I498","H2511","Z23","I10","I252","I2510","H2512","E1142","H26492","X501XXA","I110","H2181","I4820","I361","J449","S82832D","I5030","M25572","M79672","S99922A","S82432A","Z9842","E782","X58XXXA","I4819","E1165","E1122","H43813","H2513","H43811","H43812"],"date":["2025-06-11","2025-03-31","2023-12-11","2025-04-24","2025-04-24","2025-04-24","2023-10-04","2024-10-24","2024-10-24","2024-10-24","2024-10-24","2023-10-04","2025-06-11","2023-12-06","2023-12-06","2023-12-20","2024-11-01","2022-10-26","2024-12-06","2025-06-11","2023-12-11","2023-10-17","2022-11-15","2025-06-30","2023-10-23","2023-11-20","2025-06-11","2022-11-15","2025-03-31","2023-09-27","2024-01-29","2024-02-20","2023-12-07","2023-11-13","2023-11-13","2023-11-13","2023-11-15","2022-12-16","2025-06-11","2023-11-15","2025-04-24","2025-06-23","2025-06-23","2022-10-14","2022-10-14","2023-02-13","2023-02-13"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ULTRA-FINE MICRO PEN NEEDLE","","","Select","Select",""],["","","CHLORPROMAZINE HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","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":""}]}]}