{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John E Sanfason","gend":0,"currentgend":"","add":"165 CRESCENT DR","city":"North Waterboro","state":"ME","zip":"04061","dob":"1950-07-08","age":"","mstatus":"","insh":"10000041806","cliId":"","pno":2072471199,"cno":"","email":"josanfason@gmail.com","ename":"","eno":"","pphy":"GALBRAITH, KATHRYN L","ppno":"","pcpadd":"44 ELM ST,","pcpcity":"LIMERICK","pcpstate":"ME","pcpzip":"40483924","pcpcounty":"","pcpid":"","pcpname":"GALBRAITH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"165 CRESCENT DR","madd2":"","madd3":"","mcity":"North Waterboro","mstate":"ME","mzip":"04061","pcpfaxno":2077939587,"pcpnpi":1740240290,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1V79QR4HW53","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","N179","E875","E871","E1121","E119","I080","I5040","Z951","E785","I5041","A000","R0602","Z01810","I6523","E278","E039","I2510","Z20822","I110","E1165","I083","R931","I509","I25119","R0600","I5022","R051","R000","R946","J810","B86","R059","I255","J069","H6122","Z23","N401","E8770","J209","I447","R9431","Z48812","R21","I5089","N481","R300","I9789","I4891","I5042","I4729","J984","I517","H903","E669","Z515","Z7189","Z0001","E1169","R918","Z452","J90","I340","Z0101","L89152","E279","K8020","I5043","I429","Z6834"],"date":["2025-10-08","2025-02-01","2025-04-16","2025-01-24","2025-09-29","2025-09-15","2025-02-18","2025-02-18","2025-05-05","2025-10-08","2025-01-14","2025-01-12","2024-12-26","2024-12-31","2024-12-31","2025-04-04","2025-05-09","2025-06-01","2023-05-08","2025-01-03","2025-03-27","2024-12-19","2024-12-19","2024-12-30","2025-01-30","2024-12-30","2025-08-26","2024-10-23","2024-12-30","2024-08-12","2024-10-23","2024-03-20","2024-10-23","2025-03-13","2024-10-21","2024-07-19","2025-10-08","2023-11-02","2024-12-26","2023-05-08","2025-01-21","2025-01-21","2025-01-14","2024-05-30","2024-11-04","2025-10-16","2025-10-16","2025-01-30","2025-01-30","2025-06-18","2025-01-09","2025-01-08","2025-06-18","2025-01-28","2023-04-24","2025-01-06","2025-01-06","2025-10-08","2025-10-08","2025-01-06","2025-01-04","2025-01-04","2025-01-03","2025-09-15","2025-01-16","2025-01-16","2025-04-04","2025-01-03","2025-01-04","2022-10-17"],"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":[["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","PERMETHRIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TERAZOSIN 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":""}]}]}