{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Claude R Kenney","gend":0,"currentgend":"","add":"136 KENNEY RD","city":"Leeds","state":"ME","zip":"04263","dob":"1945-06-25","age":"","mstatus":"","insh":"10000039546","cliId":"","pno":2072407923,"cno":"","email":"declined@01062025.com","ename":"","eno":"","pphy":"RIVARD, GARY S","ppno":2075243501,"pcpadd":"180 CHURCH HILL RD,STE 1","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"136 KENNEY RD","madd2":"","madd3":"","mcity":"Leeds","mstate":"ME","mzip":"04263","pcpfaxno":2076476015,"pcpnpi":1194801993,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3RC6JU2DH75","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45909","I350","M9903","M5459","M9904","M533","Z950","Z09","I2510","R0602","Z01810","R0600","R339","Q141","L814","D225","L821","L570","X32XXXA","I739","R059","Z951","I5030","I10","I509","I214","Z1159","Z0000","J449","I441","R0902","I110","R001","Z48812","J90","N179","N1330","D62","J810","R338","I6523","J441","N1831","D500","K5730","K449","R918","N9989","J9811","K2211","I5033","J9621","J189","R899","J9620","J95821","R531","D649","Z952","I2584","E039","J159","N390","M5386","M9905","I080","R0609","R079","Z0189","J984","A419","J849","J9601","N170","K922","M79606","G9341","K254","R0989","J811","R0689","J939","J9691","E785","R4182","R7301","N400","E8770","I2720","R509"],"date":["2024-11-19","2025-08-05","2025-10-23","2025-03-24","2025-10-23","2025-03-24","2025-10-28","2024-10-08","2025-08-05","2025-06-09","2024-10-21","2025-05-21","2025-06-26","2025-04-01","2024-05-23","2024-05-23","2024-05-23","2024-05-23","2024-05-23","2024-10-08","2025-05-21","2025-09-02","2025-08-05","2025-08-13","2025-05-30","2023-09-12","2024-02-08","2025-02-10","2025-10-30","2024-12-18","2025-10-18","2023-09-11","2023-09-14","2025-04-14","2025-06-04","2025-10-18","2025-01-04","2025-06-26","2025-05-28","2025-07-07","2025-04-07","2025-06-20","2025-05-28","2025-06-13","2025-06-13","2025-06-13","2025-07-13","2025-10-07","2025-05-15","2025-06-13","2025-06-13","2025-06-13","2025-10-18","2025-05-12","2025-10-25","2025-06-09","2025-06-09","2025-09-19","2025-07-01","2025-03-21","2025-09-19","2025-10-18","2025-10-07","2025-10-23","2025-10-23","2024-09-11","2024-12-03","2025-05-11","2025-04-14","2025-06-09","2025-10-18","2025-10-18","2025-10-31","2025-05-01","2025-05-01","2024-01-16","2025-07-16","2025-07-20","2025-05-03","2025-05-03","2023-09-11","2023-09-11","2025-07-31","2025-09-19","2025-07-13","2025-09-19","2023-01-20","2025-05-27","2025-03-21","2025-10-16"],"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":[["","","TERAZOSIN HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUARIX 2025-2026","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","SPIRONOLACTONE-HCTZ","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","ATROVENT HFA","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NIFEDIPINE ER","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}