{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jim N Lanois","gend":0,"currentgend":"","add":"355 FISHER RD","city":"BOWDOINHAM","state":"ME","zip":"04008","dob":"1967-10-13","age":"","mstatus":"","insh":"10000046593","cliId":"","pno":2075229913,"cno":"","email":"JLANOIS3@AOL.COM","ename":"","eno":"","pphy":"GLASSPOOL, NORA G","ppno":2078731181,"pcpadd":"31 FRONT ST,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49016626","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"355 FISHER RD","madd2":"","madd3":"","mcity":"BOWDOINHAM","mstate":"ME","mzip":"04008","pcpfaxno":2078731186,"pcpnpi":1275820250,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5Y23V47QR04","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25512","M75111","R9720","N401","R351","R918","I700","Z87891","J449","I2510","F5109","F341","F4010","F339","M7502","G4733","M5481","E785","F17200","R4182","M7552","M542","Z0101","M810","H5203","H52223","H524","H0102A","H0102B","H25813","G43909","M25811","F3181","F411","F900","I10","G8918","J189","H5201","Z23","J441","R0602","F32A","M25511","R451","Z9682","F319","M1712","E878","G5621","F321","F6381","M25562","J439","I2584","L309","M75102","Z6832","Z789","R911","M7541","S46211A","X58XXXA","M19012","D751","L989","F17210","M797","J418","H25012","R6889","Z13228","G8929","G5601","J181","R55","G4710","Z720","Z79899","K219","M7551","G4700","S46212A","E538","R000","E669","M25462","M2242","M2392","G2401","Z0000","Z1283","H1789","M75112","M7582","M19011","R200","F419","I4589","M7581","I517","D649","E876"],"date":["2024-11-21","2025-03-27","2024-08-02","2024-08-02","2024-08-02","2025-02-03","2025-02-03","2024-03-28","2024-02-07","2025-02-03","2025-03-06","2025-03-06","2025-03-06","2025-03-06","2024-12-03","2025-11-11","2025-10-23","2025-05-27","2024-05-22","2024-05-22","2024-01-08","2024-01-08","2025-03-13","2025-04-24","2025-03-13","2025-03-13","2025-03-13","2024-03-12","2024-03-12","2025-03-13","2025-04-22","2025-05-14","2025-10-28","2025-10-28","2025-10-28","2025-09-30","2025-03-27","2023-02-03","2023-08-14","2025-09-25","2023-08-03","2023-06-30","2023-06-30","2025-07-22","2023-06-30","2024-11-12","2025-03-05","2023-07-18","2024-03-12","2025-06-12","2023-07-07","2023-03-08","2023-03-20","2025-02-03","2023-08-03","2023-05-26","2024-01-03","2024-05-22","2024-05-22","2025-02-03","2024-11-21","2025-03-27","2025-03-27","2024-11-21","2025-09-30","2022-11-28","2023-06-28","2023-03-15","2025-03-17","2023-01-04","2025-03-05","2023-01-31","2024-10-29","2025-01-20","2022-12-30","2023-10-10","2023-10-10","2023-04-12","2024-06-14","2025-05-27","2025-06-09","2024-02-15","2024-11-21","2024-02-09","2023-06-28","2023-10-31","2023-02-23","2023-02-23","2023-02-23","2025-10-28","2023-02-13","2023-02-13","2025-03-13","2024-04-07","2024-04-07","2025-01-14","2024-01-01","2023-06-30","2023-06-30","2025-01-14","2023-06-29","2022-08-30","2022-08-23"],"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":[["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AIMOVIG AUTOINJECTOR","","","Select","Select",""],["","","VENLAFAXINE HCL","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","BENZTROPINE MESYLATE","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LITHIUM CARBONATE ER","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUBLOK TRIVALENT 2024-2025","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","ADDERALL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AUSTEDO","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHET ER","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ATOMOXETINE HCL","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","LITHIUM CARBONATE","","","Select","Select",""],["","","FLUCELVAX QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","FLUZONE QUAD 2023-2024","","","Select","Select",""],["","","FLUBLOK QUAD 2023-2024","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}