{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roger A Grondin","gend":0,"currentgend":"","add":"29 MINTON AVENUE","city":"Sanford","state":"ME","zip":"04073","dob":"1949-12-17","age":"","mstatus":"","insh":"10000042369","cliId":"","pno":2074328650,"cno":"","email":"rogeragrondin@gmail.com","ename":"","eno":"","pphy":"KUMIN, MICHAEL C","ppno":2074519600,"pcpadd":"789 CENTRAL AVE,","pcpcity":"DOVER","pcpstate":"NH","pcpzip":"38202526","pcpcounty":"","pcpid":"","pcpname":"WHP SOUTH BERWICK FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"29 MINTON AVENUE","madd2":"","madd3":"","mcity":"Sanford","mstate":"ME","mzip":"04073","pcpfaxno":"","pcpnpi":1184795205,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1FR4E97VF96","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C44529","D485","D225","L728","L814","L821","J449","E782","J9601","J441","K219","E785","J432","J029","B353","Z08","Z85828","R0602","L570","Z87891","Z4802","R051","R0981","Z0000","Z0101","H524","M25532","D235","L089","F17210","Z20822","L578","R918","S22070A","M6740","R0902","D229","Z7189","J9600","R12","R6889","J439","R059","J159","R590","R069","C44519","A492","Z2239","R0781","I2510","R233","Z122","R634","Z23","R6881"],"date":["2025-09-23","2025-06-13","2025-06-13","2025-06-13","2025-06-13","2025-06-13","2025-11-18","2025-06-10","2025-03-04","2024-08-06","2025-08-11","2024-08-05","2025-06-16","2025-06-17","2023-06-07","2023-06-07","2023-06-07","2025-08-13","2024-12-12","2025-09-28","2025-10-08","2024-02-20","2024-02-19","2024-06-04","2024-12-17","2024-12-17","2023-06-26","2023-06-07","2023-06-07","2024-12-13","2023-08-17","2022-11-30","2024-12-13","2025-07-21","2023-06-26","2024-08-09","2024-06-06","2024-06-06","2024-08-05","2025-06-17","2023-01-01","2025-09-28","2024-02-19","2024-08-04","2025-07-21","2024-08-04","2025-09-23","2025-09-25","2025-09-25","2025-07-21","2025-04-24","2025-04-24","2022-11-15","2022-11-17","2022-10-19","2022-08-05"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","DUPIXENT PEN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":""}]}]}