{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John A Symonevich","gend":0,"currentgend":"","add":"18 TICONIC ST","city":"WATERVILLE","state":"ME","zip":"04901","dob":"1955-01-16","age":"","mstatus":"","insh":"10000041717","cliId":"","pno":2076608253,"cno":"","email":"jsymono@gmail.com","ename":"","eno":"","pphy":"PHELPS, JULIE J","ppno":2078731181,"pcpadd":"Waterville Family Practice,31 Front St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"WATERVILLE FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 TICONIC ST","madd2":"","madd3":"","mcity":"WATERVILLE","mstate":"ME","mzip":"04901","pcpfaxno":2078731186,"pcpnpi":1679562979,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1NT7QY7CH49","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R918","K449","K760","I700","C3491","Z902","R319","E1142","M549","G8929","I10","R339","R310","E1165","M5416","M48061","Z85118","M170","J189","Z98890","C3490","K8020","J9809","K222","M4726","G629","K317","Z0000","Z1331","Z23","Z139","R9720","Z125","R1310","R490","K219","J387","Z08","N320","M5450","M47816","R82998","I2510","Z1389","M7138","J029","Z20818","N400","K4090","N6489","Z79899","H81399","E876","C3431","M5116","M818","Z85810","M25561","M25461","K225","R4702","M5186","R070","R4701","Z1211","Z86010","E781","D122","D125","K621","K2100","M5136","M5417","M47817","M4807","Z466","N401","N2889","R160","Z960","C3430","M7918","M9905","D126","Z0101","H2513","M5459","M4800","M4626","R55","R0600","R079","R42","I493","I452","Z20822","G4733"],"date":["2024-08-21","2025-02-14","2025-08-01","2024-08-21","2023-09-21","2023-09-21","2024-04-03","2024-12-03","2024-06-11","2024-06-11","2024-06-11","2023-07-12","2025-09-29","2023-12-01","2023-01-11","2023-03-06","2024-08-23","2025-09-16","2025-01-08","2025-09-29","2025-08-01","2025-08-01","2023-09-13","2025-02-14","2023-01-09","2023-01-06","2025-02-14","2024-12-03","2024-12-03","2023-12-01","2024-12-03","2024-11-20","2024-11-20","2025-04-07","2025-04-07","2025-04-07","2025-03-24","2023-03-30","2024-04-01","2023-03-30","2023-03-06","2024-04-03","2025-08-01","2024-12-03","2022-12-22","2025-02-06","2025-02-06","2024-04-26","2024-04-26","2025-08-06","2025-08-06","2023-12-05","2023-12-05","2025-08-01","2023-01-09","2023-01-09","2025-03-14","2025-03-14","2025-03-14","2025-03-24","2025-03-24","2023-03-06","2025-02-07","2025-02-07","2022-11-10","2022-11-10","2022-11-18","2022-11-10","2022-11-10","2022-11-10","2022-11-18","2022-11-04","2022-10-14","2022-10-19","2022-10-19","2022-09-26","2022-09-20","2022-09-19","2022-09-19","2022-09-20","2022-09-02","2022-03-15","2022-03-17","2021-11-23","2021-12-16","2021-12-16","2022-01-07","2022-01-07","2022-01-07","2022-02-09","2022-01-10","2022-01-10","2022-01-10","2022-01-17","2022-01-10","2022-01-10","2022-02-09"],"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":[["","","FINASTERIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","OXYCODONE HCL","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}