{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charles G Drew","gend":0,"currentgend":"","add":"62 RIDGEWOOD DR","city":"FALMOUTH","state":"ME","zip":"04105","dob":"1942-12-27","age":"","mstatus":"","insh":"10000045951","cliId":"","pno":2077817580,"cno":"","email":"","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":2078381520,"add2":"","add3":"","madd1":"62 RIDGEWOOD DR","madd2":"","madd3":"","mcity":"FALMOUTH","mstate":"ME","mzip":"04105","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6MM8C64QC49","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1121","N1831","R748","L02413","L03113","Z0001","I5042","E785","K3532","R109","C44619","Z0100","K8020","K5730","Z1389","E1122","M65341","M65351","H903","D490","L720","R438","I4811","E1159","R251","E1142","R430","H33321","D0461","M8588","I5030","I442","I4891","L570","D485","Z85828","D225","M65331","D099","M8580","E1169","F3342","F411","I2510","I420","I77810","K35201","R1031","Z23","R801","I10","I130","Z950","Z7901","E875","L821","R5383","R0602","L905","K862","I480","N182","E119","I4819","R937","J8410","Z95810","I428","U071","I080","I5022","R609","M25562","M25462","R600","M1712","R21","N529","I4949","S6992XA","S01111A","S63602A","Z4802","R42","S6992XD","R809"],"date":["2025-10-10","2025-10-06","2025-05-09","2025-01-10","2025-01-10","2025-04-23","2025-10-02","2023-03-22","2024-10-04","2024-10-03","2023-11-29","2024-11-21","2024-10-03","2024-10-03","2022-12-02","2025-10-10","2024-06-14","2024-06-14","2023-03-22","2023-03-22","2023-11-29","2023-01-09","2024-07-24","2023-04-18","2025-11-04","2025-11-04","2023-05-16","2024-11-21","2024-11-12","2025-04-24","2023-12-08","2025-05-22","2023-07-31","2024-11-12","2024-11-12","2024-11-12","2024-11-12","2023-02-15","2024-12-02","2025-04-24","2025-04-24","2025-04-24","2025-04-24","2025-06-02","2024-06-13","2024-06-13","2024-10-04","2024-10-03","2024-03-29","2025-10-06","2025-10-06","2024-11-25","2025-02-18","2022-12-21","2023-11-29","2023-11-07","2023-04-07","2025-04-23","2022-11-01","2022-11-22","2022-08-25","2022-07-18","2022-07-18","2022-06-29","2022-07-07","2022-07-07","2022-06-16","2022-05-25","2022-04-05","2021-11-05","2022-02-10","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2022-01-20","2022-01-20","2022-01-20","2022-02-02","2022-02-02","2022-02-02","2022-02-10","2022-02-10","2022-02-10","2021-12-20"],"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":[["","","CEPHALEXIN","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","WARFARIN SODIUM","","","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":""}]}]}