{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George A Nickerson","gend":0,"currentgend":"","add":"23 LOUNDER DR","city":"WEST BATH","state":"ME","zip":"04530","dob":"1947-11-01","age":"","mstatus":"","insh":"10000042716","cliId":"","pno":2073574569,"cno":2073574569,"email":"DGNICK72@YAHOO.COM","ename":"","eno":"","pphy":"CARDELLA, AMANDA D","ppno":2077984400,"pcpadd":"Martins Point Health Care,PO Box 9746","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04104","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"23 LOUNDER DR","madd2":"","madd3":"","mcity":"WEST BATH","mstate":"ME","mzip":"04530","pcpfaxno":2077984018,"pcpnpi":1902219389,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8D83J37MX85","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C61","R9720","R52","M5412","M25512","M6281","Z0000","Z2839","R778","R2689","R293","R1013","M1990","M1120","M41114","R899","I10","E7800","Z125","Z1329","Z510","M542","M79642","R0602","I2510","M069","M2550","Z0101","M4802","M19012","M75122","R531","R748","R202","Z79899","M25611","M25612","M5030","M47812","M4312","R9089","I6782","R269","I4581","M129","I700","R350","Z923","R3915","H25093","R7989","D7589","D509","S63256A","M19041","M7989","M5033","G959","M353","H5203","H52223"],"date":["2025-09-12","2025-04-23","2024-04-01","2024-05-16","2024-05-16","2024-11-11","2025-08-08","2023-07-25","2023-10-06","2024-11-11","2024-11-11","2023-03-07","2024-03-19","2025-05-22","2023-03-23","2024-08-12","2024-07-30","2025-08-08","2024-07-25","2024-07-25","2025-06-21","2024-05-16","2024-09-03","2024-07-30","2024-07-30","2024-07-30","2024-09-03","2024-11-12","2024-07-18","2024-04-22","2024-04-22","2024-10-21","2024-09-03","2025-05-22","2025-05-22","2024-06-18","2024-06-18","2024-07-18","2024-07-18","2024-07-18","2024-06-09","2024-06-09","2024-06-09","2024-08-23","2024-04-01","2024-07-29","2025-07-23","2025-07-23","2025-07-23","2023-10-05","2023-09-22","2023-09-22","2024-06-06","2024-09-03","2024-09-03","2024-09-03","2024-01-29","2024-07-18","2024-03-19","2022-09-29","2022-09-29"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BISOPROLOL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}