{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Otho O Stanley","gend":0,"currentgend":"","add":"167 PATTAGUMPUS RD 369","city":"Medway","state":"ME","zip":"04460","dob":"1950-03-18","age":"","mstatus":"","insh":"10000040223","cliId":"","pno":2077465122,"cno":"","email":"Franstanley52@yahoo.com","ename":"","eno":"","pphy":"AQUILINA, JOSEPH","ppno":2072230965,"pcpadd":"PO BOX 99,","pcpcity":"LINCOLN","pcpstate":"ME","pcpzip":"44570099","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"167 PATTAGUMPUS RD 369","madd2":"","madd3":"","mcity":"Medway","mstate":"ME","mzip":"04460","pcpfaxno":2077946777,"pcpnpi":1104835669,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3QM8WH4NR21","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B078","K529","M23204","M5442","E119","R9431","S0003XA","E1169","Z471","Z01818","M1712","Z0000","Z122","H401131","H57813","E785","S83232D","M9915","M9916","M9912","M9911","R6889","H402230","Z86010","N289","R7301","J069","Z1152","Z87891","M25562","S83231A","U071","Z0101","H524","H5203","Z1211","D123","K621","E559","S0990XA","I10","M5137","M47816","Z96652","K760","N200","N281","Z01812","B079","R059","R509","Z09","H25813","Z136"],"date":["2023-08-28","2024-06-20","2024-03-01","2023-11-12","2023-11-20","2025-07-14","2025-02-27","2025-01-17","2025-08-05","2025-06-27","2025-07-07","2023-11-27","2025-01-13","2024-02-13","2023-08-11","2024-04-01","2024-08-01","2025-01-02","2025-01-02","2025-01-02","2025-01-02","2023-12-28","2024-08-13","2024-05-08","2024-08-22","2023-05-24","2024-01-29","2024-01-29","2025-01-13","2024-02-21","2024-02-21","2022-12-28","2025-03-04","2025-03-04","2025-03-04","2024-07-10","2024-07-10","2024-07-10","2024-06-27","2025-02-27","2023-05-19","2023-11-12","2023-11-12","2025-07-25","2024-06-20","2024-08-22","2024-08-22","2025-05-05","2023-08-29","2024-06-20","2024-06-20","2024-07-10","2022-07-20","2022-06-06"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TRAVATAN Z","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","ALPHAGAN P","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","TRAVOPROST","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","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":""}]}]}