{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dean H Gulezian","gend":0,"currentgend":"","add":"105 AUTUMN RIDGE RD","city":"CUMBERLAND","state":"ME","zip":"04021","dob":"1950-12-19","age":"","mstatus":"","insh":"10000044507","cliId":"","pno":2077495208,"cno":"","email":"noanswer@noanswer.com","ename":"","eno":"","pphy":"CATHCART, SCOTT","ppno":2077745816,"pcpadd":"Intermed,84 Marginal Way Ste 700","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"105 AUTUMN RIDGE RD","madd2":"","madd3":"","mcity":"CUMBERLAND","mstate":"ME","mzip":"04021","pcpfaxno":"","pcpnpi":1659876571,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2VC4W06PX98","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","Z1159","E785","Z114","M25551","Z96641","M5450","M48062","Z1211","N5089","Z0100","H43811","H2513","H5213","H524","H52203","M5416","R918","H3589","H3562","Z471","Z96643","M5117","M4727","Z4789","R6889","Z96642","M48061","Z0001","E804","R7989","R9389","J069","J101","M79604","N503","I861","M4726","M5116","U071","R0989","J90","M160","Z01812","M1612","N400","Z79899","M25552","R4182","S30860A","M1611","R0982","R490","D140","Z125"],"date":["2025-05-12","2025-05-12","2025-05-12","2025-05-12","2024-10-21","2024-10-21","2024-10-21","2025-08-12","2024-10-04","2025-05-14","2023-01-23","2025-02-26","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2025-04-28","2022-12-05","2025-02-26","2025-02-26","2024-07-25","2024-07-25","2025-02-07","2025-02-07","2025-09-22","2023-03-20","2024-07-25","2025-06-09","2025-05-02","2024-04-26","2023-01-17","2022-12-05","2025-01-22","2025-01-22","2025-06-09","2025-05-14","2025-05-14","2025-02-21","2025-02-21","2022-11-11","2022-11-11","2022-11-11","2022-06-08","2022-06-05","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-04","2022-04-21","2022-03-21","2022-03-21","2022-03-21","2022-01-13"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ADACEL TDAP","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2021-22","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}