{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gary L Tuttle","gend":0,"currentgend":"","add":"1115 SUMMERHAVEN ROAD","city":"Augusta","state":"ME","zip":"04330","dob":"1947-12-29","age":"","mstatus":"","insh":"10000046654","cliId":"","pno":2076226678,"cno":"","email":"bumpz@roadrunner.com","ename":"","eno":"","pphy":"MADDEN, AMY K","ppno":2076261561,"pcpadd":"PO BOX 274,","pcpcity":"BELGRADE","pcpstate":"ME","pcpzip":"04917","pcpcounty":"","pcpid":"","pcpname":"BELGRADE REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1115 SUMMERHAVEN ROAD","madd2":"","madd3":"","mcity":"Augusta","mstate":"ME","mzip":"04330","pcpfaxno":2074953353,"pcpnpi":1508975152,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XM6E50EJ74","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79605","E039","E119","M5432","Z23","N289","Q446","N281","R932","L570","L821","L738","D2372","L723","M5450","E11319","Z0000","L820","I493","I491","I4710","I726","D485","R208","R361","S20462A","W57XXXA","L7211","M25511","I080","R252","E785","I25118","A6920","I10","E7800","S80862A","Z8679","M47816","Q631","H2513","Z139","K769","K7689","M7910","H3562","R300"],"date":["2025-05-05","2025-08-06","2025-11-03","2025-05-27","2024-11-01","2024-08-23","2024-08-23","2024-08-23","2024-08-23","2025-07-21","2025-07-21","2025-07-21","2025-07-21","2025-07-21","2025-07-11","2023-04-14","2024-05-01","2025-10-15","2024-04-23","2024-03-18","2024-03-18","2025-01-14","2024-07-16","2025-10-15","2023-08-03","2025-06-02","2025-06-02","2025-10-15","2023-07-12","2024-04-23","2023-04-26","2024-05-01","2024-04-23","2023-06-07","2024-05-01","2025-02-27","2023-06-07","2023-06-07","2025-07-05","2025-09-10","2024-06-18","2024-01-24","2024-06-19","2024-06-19","2025-06-22","2022-09-27","2022-09-14"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LABETALOL HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","NITROGLYCERIN","","","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":""}]}]}