{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas P Fahey","gend":0,"currentgend":"","add":"60 ALLENWOOD PARK RD","city":"Augusta","state":"ME","zip":"43300913","dob":"1960-03-30","age":"","mstatus":"","insh":"10000046459","cliId":"","pno":2075925733,"cno":"","email":"tomfahey.812@yahoo.com","ename":"","eno":"","pphy":"BROWN, JASON","ppno":2076218800,"pcpadd":"Augusta Family Medicine,15 Enterprise Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"AUGUSTA FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"60 ALLENWOOD PARK RD","madd2":"","madd3":"","mcity":"Augusta","mstate":"ME","mzip":"43300913","pcpfaxno":2076218801,"pcpnpi":1740592658,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2QM5P99HM67","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K7460","Z0000","M5442","Z1211","M5441","G8929","M5417","Z79891","M9901","M9900","M9903","M9905","R161","M19011","M25511","M25512","M19012","E7800","G894","K5900","R351","Z538","K3189","E669","Z6839","R739","M25552","Z23","I10","Z0100","K7402","M5416","K760","Z8619","F1091","M25462","M1712","M25562","M79605","X501XXA","K5730","K648","Z860101","M10021","M720","M10221","Z6841","K769","F1190","R6889","F1120","R0789"],"date":["2025-11-13","2025-10-28","2025-03-06","2025-04-10","2025-06-20","2025-10-23","2024-12-11","2025-10-23","2024-11-13","2024-11-13","2024-11-13","2024-11-13","2024-11-13","2025-04-23","2025-07-09","2025-07-09","2025-04-23","2025-10-29","2025-01-07","2025-10-23","2024-09-16","2025-03-05","2025-03-05","2024-02-26","2023-10-12","2023-04-13","2023-04-13","2023-04-13","2025-10-03","2025-09-30","2025-04-17","2024-08-01","2025-04-17","2025-04-17","2025-04-17","2024-04-18","2024-04-18","2024-04-18","2024-04-18","2024-04-18","2025-04-10","2025-04-10","2025-04-10","2023-01-05","2023-07-13","2023-07-13","2023-03-02","2025-09-11","2025-09-11","2023-09-27","2024-08-29","2022-10-13"],"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":[["","","MORPHINE SULFATE","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","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":""}]}]}