{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James T Collins","gend":0,"currentgend":"","add":"128 MADELINE ST","city":"Portland","state":"ME","zip":"04103","dob":"1946-08-06","age":"","mstatus":"","insh":"10000041207","cliId":"","pno":2077736586,"cno":"","email":"declined@12162024.com","ename":"","eno":"","pphy":"RIDDLEBERGER, JAMES M","ppno":2078282402,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"128 MADELINE ST","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04103","pcpfaxno":2078282433,"pcpnpi":1114308277,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1G11J66KM09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E871","I358","R931","E222","R42","R270","N401","N3941","R55","M47816","G8929","N419","G4733","G4730","R300","F419","M48061","R1030","Z79899","R102","R399","F3341","R1032","N138","N3281","Z13228","E785","E039","M5416","N281","G479","M542","F322","F4323","R45851","F325","F32A","J40","G4719","R0683","M47812","M4312","N50812","C44519","I861","I739","R350","B356","R030","C7989","C801","N411","E559","Z0100","L308","L578","L821","Z85828","R0602","T380X5A","F068","S2241XA","I70213","M50320","C4442","Z87891","N5082","Z923","F4321","D492","D225","R200","R202","R0781","M5450","Z98890","M5459","K5900","R6889","M4316","F329","R5383","K219","E669","D649","K7689","R109","K5909","Z23","N400","R1031"],"date":["2025-01-03","2024-12-31","2024-12-31","2024-12-30","2025-01-01","2024-12-30","2025-07-08","2024-09-13","2025-01-01","2025-05-13","2025-05-13","2024-04-10","2025-11-09","2025-09-09","2025-04-24","2024-11-14","2023-05-11","2025-05-13","2024-06-13","2024-06-20","2024-03-07","2024-11-14","2024-11-14","2025-07-08","2025-04-24","2023-04-18","2025-03-19","2025-03-19","2025-11-11","2023-02-20","2023-02-07","2024-03-22","2023-01-23","2023-07-27","2023-01-22","2023-01-28","2023-02-27","2024-12-30","2025-07-31","2025-07-31","2024-03-22","2024-03-22","2022-12-11","2023-08-25","2023-01-05","2025-07-11","2024-08-28","2024-05-03","2025-05-21","2023-09-06","2023-09-06","2024-05-28","2025-03-19","2022-12-28","2025-05-29","2025-05-29","2025-05-29","2025-05-29","2023-01-22","2022-12-04","2022-12-04","2023-01-17","2025-07-11","2023-06-01","2022-12-05","2022-12-05","2023-01-05","2023-01-05","2023-01-10","2023-07-10","2024-08-05","2023-06-01","2023-06-01","2023-01-17","2023-03-17","2023-03-07","2023-03-07","2023-03-02","2023-03-16","2023-03-17","2023-01-22","2024-03-14","2022-11-07","2022-11-07","2022-10-31","2022-10-27","2022-11-20","2022-11-20","2022-10-06","2022-09-30","2022-09-30"],"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":[["","","NALOXONE HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","SILODOSIN","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ZONISAMIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DRIZALMA SPRINKLE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}