{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter G Castonia","gend":0,"currentgend":"","add":"186 MIDDLE ROAD","city":"CUMBERLAND CENTER","state":"ME","zip":"04021","dob":"1947-05-05","age":"","mstatus":"","insh":"10000045609","cliId":"","pno":2074150675,"cno":2074150675,"email":"nancy.castonia@gmail.com","ename":"","eno":"","pphy":"MARTIN, STEPHEN","ppno":2078469013,"pcpadd":"Intermed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"186 MIDDLE ROAD","madd2":"","madd3":"","mcity":"CUMBERLAND CENTER","mstate":"ME","mzip":"04021","pcpfaxno":2078741483,"pcpnpi":1740249861,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5M29K50TN11","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z950","Z5189","I69320","G4733","I639","E1159","T45615A","I629","G4739","R262","S88111D","R4701","R480","I6349","I615","Z66","G9349","E1169","D6862","J8489","E1142","R339","N1830","K5909","M25511","I63512","E1122","E782","F3341","N281","N179","I77810","I080","Z95818","Z89511","G9340","N1832","I63412","Z7901","Z0000","E1165","I63312","G8191","M48061","M5116","M4726","Z4509","E1121","E1151","E1136","Z794","Z9641","R791","G4737","I6523","M5417","E662","Z48812","R42","E785","K219","M19011","I499","Z8673","Z125","Z0001","G4761","I69328","I69398","R2681","I129","E1140","Z7409","F32A","I442","I6389","I63511","S301XXA","K5730","Z23","J9811","M75111","R809","Z9181","R519","I10","M7989","M25472","H8110","E781","G4731","R531","I4891","H01001","H01004","M67813","Z1211","J449","R7989","Z0101","T82120A","S8992XA","Z113","D6861","G9389","N189","Z736","H5789","M9903","M9906","S83411A","M25552","M5450","S76312D","M47816","M4316","M549","H40011","H21231","H40051","H25813","I440","I471","I441","I491","I214","I739","I5A","R29818","H21233","H2513","H8112","H532","I151","H25013","H17811","H43391","Z03818","J069","R6889"],"date":["2025-10-30","2024-06-28","2025-11-12","2025-10-19","2025-09-16","2023-12-11","2023-04-26","2023-05-10","2024-06-28","2025-10-27","2025-10-27","2025-10-27","2022-11-30","2023-04-20","2023-04-22","2023-04-20","2023-05-10","2023-09-18","2025-11-04","2023-05-10","2025-10-27","2023-06-07","2024-08-07","2023-05-23","2023-08-28","2025-01-31","2023-10-24","2023-05-25","2023-05-25","2023-05-13","2024-06-21","2025-08-07","2025-08-07","2024-11-21","2025-06-13","2023-05-15","2025-04-30","2023-05-10","2025-09-16","2025-04-22","2025-11-04","2023-05-11","2023-05-11","2023-01-15","2023-01-15","2023-01-15","2025-01-31","2025-07-24","2023-06-19","2023-06-19","2025-07-24","2025-07-24","2023-08-14","2025-09-02","2024-06-05","2023-01-15","2023-07-28","2023-06-16","2024-06-21","2025-02-06","2025-02-06","2024-08-02","2023-04-24","2025-02-03","2023-01-25","2025-01-30","2023-06-29","2023-06-13","2023-06-13","2023-06-13","2023-06-07","2023-06-09","2023-06-13","2023-06-13","2025-07-29","2023-05-12","2023-04-23","2023-05-11","2023-05-13","2024-10-22","2023-05-13","2024-08-02","2022-11-30","2023-07-05","2023-04-20","2025-02-06","2023-06-01","2023-06-01","2024-06-12","2024-07-17","2024-05-28","2024-06-05","2024-12-04","2023-12-19","2023-12-19","2024-07-23","2025-02-19","2024-08-02","2024-02-23","2025-02-13","2025-02-06","2024-06-10","2025-01-30","2024-06-07","2024-06-06","2024-06-21","2024-06-21","2023-12-04","2024-06-18","2024-06-18","2024-06-18","2022-10-05","2022-10-05","2022-10-05","2022-10-20","2022-10-20","2022-10-20","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-09-14","2022-09-14","2022-07-25","2022-07-25","2022-07-15","2022-07-15","2022-07-14","2022-07-13","2022-04-28","2022-03-23","2021-11-15","2021-11-15","2021-11-12","2021-12-08","2021-12-08","2021-12-08","2021-10-22","2021-10-22","2022-02-02"],"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":[["","","OMNIPOD 5 DEXG7G6 PODS (GEN 5)","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","TRADJENTA","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","TOUJEO MAX SOLOSTAR","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","OMNIPOD 5 DEXG7G6 INTRO(GEN 5)","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","DEXCOM G6 RECEIVER","","","Select","Select",""],["","","RISPERIDONE ODT","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ONETOUCH VERIO FLEX METER","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","OMNIPOD 5 G6 INTRO KIT (GEN 5)","","","Select","Select",""],["","","OMNIPOD 5 G6 PODS (GEN 5)","","","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":""}]}]}