{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Frederick A Jones","gend":0,"currentgend":"","add":"13 CLOVER WAY UNIT 1","city":"Falmouth","state":"ME","zip":"04105","dob":"1948-10-25","age":"","mstatus":"","insh":"10000044422","cliId":"","pno":2076533952,"cno":"","email":"FAJONESJUNIOR26@GMAIL.COM","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":2077745816,"pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"13 CLOVER WAY UNIT 1","madd2":"","madd3":"","mcity":"Falmouth","mstate":"ME","mzip":"04105","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8QT1PF0DN13","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M7989","H40013","Z0000","M25572","E039","R739","N400","D3132","E7800","Z0101","R2232","R2231","L921","L928","M659","R21","H7390","R7303","M1711","D492","M898X4","M19022","M7731","Z0001","K635","Z86010","Z800","K5730","M7121","Z1159","H6123","L570","D485","Z85828","L578","Z23","Z791","M25522","M7022","C44629","L821","D225","D0462","M1712","H903","H9313","M9903","M5441","M5136","M9905","M25562","M1710","M25462","M7122","Z125","H9193","M25561"],"date":["2024-04-26","2025-08-21","2023-01-13","2024-06-20","2025-06-18","2024-05-01","2025-06-18","2023-06-15","2025-06-18","2025-08-21","2025-08-29","2024-02-01","2024-04-26","2024-04-26","2024-06-20","2024-08-09","2024-04-19","2025-06-26","2022-12-30","2024-08-09","2023-07-31","2025-06-26","2025-06-26","2025-06-20","2024-08-28","2024-08-28","2024-08-28","2024-08-28","2022-12-16","2025-06-18","2024-01-19","2023-06-28","2023-06-28","2024-08-09","2024-08-09","2025-06-20","2025-02-21","2025-09-30","2025-09-30","2022-06-24","2022-06-24","2022-06-24","2022-06-24","2022-03-25","2022-03-08","2022-03-08","2021-10-18","2021-10-29","2021-10-18","2021-10-18","2021-10-29","2021-10-29","2021-12-01","2021-12-01","2022-01-02","2022-01-07","2022-02-22"],"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":[["","","INDOMETHACIN","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","PAXLOVID (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":""}]}]}