{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eugene A Mann","gend":0,"currentgend":"","add":"112 TYLER ST PILLAR 5 BOX 6","city":"Newport","state":"ME","zip":"04953","dob":"1949-02-05","age":"","mstatus":"","insh":"10000040160","cliId":"","pno":2073414462,"cno":"","email":"OPTOUT@07272021.COM","ename":"","eno":"","pphy":"WEBB, TIMOTHY S","ppno":2078726869,"pcpadd":"Elmwood Primary Care,221 Main St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"ELMWOOD PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"112 TYLER ST PILLAR 5 BOX 6","madd2":"","madd3":"","mcity":"Newport","mstate":"ME","mzip":"04953","pcpfaxno":2078773401,"pcpnpi":1376602276,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7EM2QQ8UC10","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E118","I69998","R001","C44311","T839XXA","I639","I69331","Z87891","M21371","N401","E1142","I10","R339","R9720","R0683","G4733","E119","I6930","Z0000","R338","E11319","Z0130","Z1211","Z8673","C44212","E039","M7061","Z7982","Z7902","D485","L570","L814","D225","L821","Z7984","R3912","E669","Z6832","Z122","N400","R42","Z0001","E785","I69898","Z961","R030","X32XXXA","Z08","I69351","Z9989","I6381","E8342","E7800","E1165","F17210","L989","M7071","Z79899","I69359","M21379","R519","M62838","N139","K5900","I69828","I69951","I69921","I69322"],"date":["2025-04-29","2025-01-02","2023-07-26","2024-10-21","2023-05-19","2023-01-06","2022-12-02","2023-08-16","2024-12-16","2024-02-27","2024-04-01","2024-06-17","2024-02-21","2025-03-04","2023-08-16","2023-08-07","2025-10-15","2023-08-14","2023-05-12","2024-02-27","2025-07-02","2023-09-01","2024-04-01","2024-06-12","2025-08-05","2025-01-03","2025-09-14","2025-01-14","2023-08-14","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-08-05","2025-04-29","2024-02-27","2023-08-16","2023-08-16","2024-03-21","2023-09-13","2025-05-07","2024-06-04","2023-06-06","2024-09-10","2024-09-10","2023-05-15","2025-08-05","2025-08-05","2023-12-06","2023-04-13","2023-06-21","2023-05-12","2023-05-12","2023-08-11","2023-08-11","2023-08-11","2025-09-14","2024-06-12","2023-01-10","2023-01-10","2022-10-31","2022-09-21","2022-07-17","2022-07-17","2022-07-29","2022-07-29","2022-07-15","2022-07-04"],"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":[["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PIOGLITAZONE HCL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","GLUCOCARD EXPRESSION","","","Select","Select",""],["","","UNILET LANCETS","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","UNILET COMFORTOUCH","","","Select","Select",""],["","","GLUCOCARD VITAL","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","MICROLET","","","Select","Select",""],["","","GLUCOCARD VITAL SENSOR","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","EMBRACE PRO TEST STRIP","","","Select","Select",""],["","","METFORMIN HCL ER","","","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":""}]}]}