{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mark R Austin","gend":0,"currentgend":"","add":"7 TOWN AND COUNTY RD","city":"Lisbon","state":"ME","zip":"04250","dob":"1954-09-04","age":"","mstatus":"","insh":"10000039515","cliId":"","pno":2072322113,"cno":"","email":"mrasgt@gmail.com","ename":"","eno":"","pphy":"STOCKWELL, GEORGE W","ppno":2078930290,"pcpadd":"144 STATE ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41013776","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 TOWN AND COUNTRY RD","madd2":"","madd3":"","mcity":"Lisbon","mstate":"ME","mzip":"04250","pcpfaxno":2078930295,"pcpnpi":1548293772,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4NK8C43TH23","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S62502A","L84","E1142","L603","F5101","R600","L600","B351","M9906","M25551","M9903","M5451","S62619D","S62512D","M19042","S62512A","G4709","E1140","G4762","M5430","L03031","M79674","G4700","Z01818","R400","F4323","G4733","U071","S62509A","F988","E119","M160","H6691","R059","I83811","J310","M1611","R2689","Z96641","Z471","Z1211","D120","D124","D125","J069","H6123","R6889","H5711","M79643","S61212A","W208XXA","Z888","J209","M722","M79671","R053","F951","Z09","M62831","Z125","Z98890","F909","R4182","R918","D123","M47816","J849","M79673","M79605","M79604","Z0000","K219","J383","G2581","I10","H10412"],"date":["2025-05-16","2024-12-16","2025-01-17","2024-12-16","2025-08-21","2025-08-27","2025-07-02","2023-06-27","2023-07-11","2025-07-07","2023-07-11","2023-07-11","2025-05-15","2025-05-15","2025-06-23","2025-05-15","2025-05-29","2025-08-08","2025-09-30","2025-09-08","2025-07-02","2025-07-02","2024-03-11","2024-04-08","2024-02-07","2024-09-17","2025-06-30","2023-12-20","2025-05-19","2024-08-26","2025-11-07","2024-02-26","2025-06-26","2025-01-23","2025-09-30","2025-03-08","2024-03-20","2025-02-19","2025-07-07","2025-07-07","2025-01-20","2025-01-20","2025-01-20","2025-01-20","2025-02-21","2025-06-24","2023-01-15","2025-09-30","2025-06-23","2024-11-10","2024-11-10","2024-11-10","2024-05-22","2024-05-29","2024-05-29","2025-02-11","2025-02-11","2025-01-06","2025-01-17","2025-07-24","2024-03-20","2024-03-20","2024-03-20","2025-03-25","2025-01-20","2024-04-08","2025-03-25","2022-10-07","2022-10-07","2022-10-07","2022-10-06","2022-08-11","2022-08-11","2022-04-19","2022-04-19","2022-04-12"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","BELSOMRA","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","GLIMEPIRIDE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ESZOPICLONE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","PIOGLITAZONE HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","METHYLPHENIDATE HCL","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","TRIAZOLAM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ARMODAFINIL","","","Select","Select",""],["","","DAYVIGO","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CARBAMAZEPINE ER","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","RIZATRIPTAN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","METHYLPHENIDATE ER (LA)","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","HYDROMORPHONE ER","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","TRAMADOL HCL ER","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANC DEV","","","Select","Select",""],["","","TEMAZEPAM","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","CYPROHEPTADINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ALREX","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}