{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brian R Mauro","gend":0,"currentgend":"","add":"865 LEWISTON RD","city":"Topsham","state":"ME","zip":"04086","dob":"1958-07-16","age":"","mstatus":"","insh":"10000039984","cliId":"","pno":2075040606,"cno":"","email":"declined@06042024.com","ename":"","eno":"","pphy":"RABY, NATHAN C","ppno":2079982100,"pcpadd":"Community Health Center,364 Maine St","pcpcity":"Poland","pcpstate":"ME","pcpzip":"04274","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"865 LEWISTON RD","madd2":"","madd3":"","mcity":"Topsham","mstate":"ME","mzip":"04086","pcpfaxno":"","pcpnpi":1770528143,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5V74EC4TV62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25562","Z4789","K5792","M542","I10","R059","H5789","R079","E119","E785","D649","R0789","Z1152","M25662","M25551","I4891","M23222","M23201","M25559","N281","R072","S83232A","M26622","N401","Z7901","S61219A","M5450","J449","M1712","D125","D120","S83242A","K219","R195","Z1211","D509","K5732","Z0000","Z09","K760","M2242","S83282A","R053","J329","H35372","H43313","H43391","K5730","R109","E7800","H00012","M19042","M19032","R001","Z9049","I491","N481","L03213","Z20822","I499"],"date":["2024-06-12","2024-05-17","2025-06-11","2025-06-11","2025-08-19","2025-02-03","2025-07-16","2025-11-10","2025-08-14","2025-08-19","2024-05-02","2025-08-14","2023-12-20","2024-01-03","2024-08-29","2025-08-19","2024-02-16","2024-02-16","2024-09-19","2024-07-24","2025-08-14","2024-02-16","2023-03-28","2023-06-06","2025-07-29","2025-06-08","2023-05-19","2025-05-27","2024-07-22","2023-09-11","2023-09-11","2024-02-16","2024-02-16","2023-09-11","2023-05-22","2024-04-23","2025-03-26","2024-11-08","2024-07-23","2025-03-26","2024-04-01","2024-02-16","2025-02-24","2025-02-24","2025-06-12","2025-06-12","2025-06-12","2025-03-26","2023-07-18","2023-05-01","2024-08-01","2025-07-16","2025-07-16","2024-05-23","2023-07-18","2022-08-08","2022-07-06","2022-06-19","2022-04-15","2022-04-15"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TERAZOSIN HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","GLIPIZIDE XL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUBLOK QUAD 2022-2023","","","Select","Select",""],["","","FLUZONE QUAD 2022-2023","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","ONETOUCH DELICA","","","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":""}]}]}