{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Steven A Cassidy","gend":0,"currentgend":"","add":"20 BADGERS HIGHLAND WEST","city":"KITTERY","state":"ME","zip":"03904","dob":"1950-10-12","age":"","mstatus":"","insh":"10000043817","cliId":"","pno":6035028174,"cno":"","email":"stevecass@comcast.net","ename":"","eno":"","pphy":"BERMAN, MARK A","ppno":6037427338,"pcpadd":"Bellamy Health Center,15 Old Rollinsford Rd","pcpcity":"Dover","pcpstate":"NH","pcpzip":"03820","pcpcounty":"","pcpid":"","pcpname":"WHP BELLAMY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 54","madd2":"","madd3":"","mcity":"KITTERY POINT","mstate":"ME","mzip":"03905","pcpfaxno":6037409528,"pcpnpi":1972559367,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6H86XK7TY46","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F902","I719","I728","I77811","I7121","H25811","M47817","G894","M47816","M48061","H40013","E785","Z79891","I7120","I351","H43813","C61","I10","E7800","E7439","H25812","D485","L298","L728","L821","D225","K5900","H35372","M21371","H25813","M5116","F1290","D229","L578","X32XXXA","Z1283","L570","H16223","D3617","R0609","I708","I700","D1809","I2510","I440","R001","Z1339","K8689","R161","D1803","K769","Z01812","Z0000","E871","Z23","I7090","Q2733","K5730","I77810","G4700"],"date":["2025-10-06","2024-07-22","2024-07-29","2024-07-29","2024-11-21","2025-05-20","2023-09-14","2025-09-23","2025-09-23","2025-03-13","2025-09-12","2025-10-06","2025-09-23","2025-05-27","2024-12-16","2023-12-14","2024-04-12","2023-06-20","2023-06-20","2023-06-20","2025-04-22","2024-01-30","2024-01-30","2024-01-30","2024-01-30","2024-01-30","2024-02-20","2025-10-30","2024-10-02","2025-03-05","2025-01-07","2025-01-07","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2024-06-26","2024-01-30","2023-05-11","2024-05-16","2024-05-16","2023-03-16","2025-10-01","2025-03-04","2025-03-04","2022-11-30","2023-03-16","2023-03-16","2023-03-16","2023-03-16","2024-05-15","2022-10-25","2022-10-25","2022-10-25","2022-07-15","2022-07-15","2022-07-15","2022-06-22","2022-06-22"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","MORPHINE SULFATE ER","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","BROMFENAC SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)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":""}]}]}