{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charles V Barry","gend":0,"currentgend":"","add":"5 STAGE COACH DRIVE","city":"OLD ORCHARD BEACH","state":"ME","zip":"04064","dob":"1942-05-02","age":"","mstatus":"","insh":"10000045844","cliId":"","pno":2079341250,"cno":"","email":"opt-out@optout.com","ename":"","eno":"","pphy":"GEIGER, ROBERTA L","ppno":2078731036,"pcpadd":"Wells Primary Care of York Hospital,112 Sanford Rd Dept Primary Care","pcpcity":"Wells","pcpstate":"ME","pcpzip":"04090","pcpcounty":"","pcpid":"","pcpname":"WELLS PRIMARY CARE OF YORK HOSPITAL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 STAGE COACH DRIVE","madd2":"","madd3":"","mcity":"OLD ORCHARD BEACH","mstate":"ME","mzip":"04064","pcpfaxno":2072893104,"pcpnpi":1659654671,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7JN1AY2PV15","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I083","C44212","C44222","C44229","L814","K458","K4090","D539","M5450","M48061","M5117","M4727","E119","E8342","H25011","I2510","M5416","M5126","M4810","H6121","R0789","S79912A","I10","D696","Z743","M7918","R079","H2513","S51851A","Z951","I3481","N189","N281","H25012","I509","L570","L578","Z85828","L821","E876","E1142","S51851D","W540XXD","K219","R6881","D8989","H01021","H04523","Z7689","W540XXS","R0602","I209","Z23","W540XXA","I110","E785","Z7185","Z87891","T148XXA","R8290","R4182","I25119","C44329","D485","Z0000","R001","I441","I517","I519","I350","D492","R350","R531","R1314","K222","K253","C4442"],"date":["2025-03-27","2025-07-16","2025-07-16","2025-07-16","2025-07-16","2024-06-12","2025-07-10","2025-10-06","2024-11-15","2024-09-20","2024-09-20","2024-09-20","2024-11-25","2025-01-03","2023-07-26","2025-05-07","2025-01-06","2024-10-17","2024-10-17","2023-10-04","2023-01-05","2024-09-10","2025-01-23","2025-10-06","2022-12-25","2024-09-10","2023-08-14","2023-05-23","2025-07-02","2025-03-27","2025-03-27","2025-06-17","2025-06-17","2023-08-07","2023-08-14","2025-07-16","2025-07-16","2025-07-16","2025-07-16","2024-12-06","2025-01-17","2025-07-09","2025-07-09","2025-10-07","2025-10-07","2025-10-06","2023-06-23","2023-06-23","2025-07-15","2025-07-02","2024-02-02","2023-01-31","2025-07-24","2025-07-15","2023-08-14","2024-02-02","2025-07-06","2025-07-06","2025-07-06","2025-06-17","2023-07-26","2023-01-17","2023-03-17","2023-03-17","2023-09-29","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2025-07-16","2023-08-14","2024-12-09","2022-10-04","2022-08-18","2022-07-19","2022-07-05"],"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":[["","","ATENOLOL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","GENTAMICIN SULFATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","LANCETS ULTRA THIN","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}