{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul P Grant","gend":0,"currentgend":"","add":"11 GRANT RD","city":"LYMAN","state":"ME","zip":"04002","dob":"1948-07-07","age":"","mstatus":"","insh":"10000046706","cliId":"","pno":2072478853,"cno":"","email":"declined@04032025.com","ename":"","eno":"","pphy":"CUTONE, JENNIFER A","ppno":2074673200,"pcpadd":"Internal Medicine of Southern Maine,2 Independence Dr Ste B","pcpcity":"Kennebunk","pcpstate":"ME","pcpzip":"04043","pcpcounty":"","pcpid":"","pcpname":"INTERNAL MEDICINE OF SOUTHERN MAINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 GRANT RD","madd2":"","madd3":"","mcity":"LYMAN","mstate":"ME","mzip":"04002","pcpfaxno":2074673207,"pcpnpi":1003879909,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5DY8J94PC58","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B351","E1159","K635","K5730","K529","M75112","M51370","M25512","G8918","E785","E669","L219","L728","L578","S46012A","Z98890","M7532","M19012","Z87891","Z122","R339","N401","N138","R600","Z23","L600","I10","E119","Z125","J209","L723","I7091","M79674","L602","F17210","D492","L570","Z760","D122","E538","M7542","M7522","M7552","M5450","L280","H61002","E539","M47816","M48061","I371","M7989","L02213","L720","L03818","B353","R197","D125","J449","M2550","M5137","F17200","R059","J069","H5211","D3131","K659","G250","Z0000","F17290","M25571","D519","K439"],"date":["2025-10-10","2025-10-10","2025-10-28","2025-10-28","2025-10-28","2025-06-18","2025-11-17","2025-03-26","2025-03-12","2025-10-03","2025-03-12","2025-01-14","2024-09-17","2025-01-14","2025-03-12","2025-08-05","2024-10-23","2025-06-06","2025-11-04","2025-11-04","2025-09-04","2025-09-04","2025-09-04","2025-07-02","2025-10-16","2024-03-04","2024-10-01","2025-10-07","2025-10-03","2025-04-25","2025-09-05","2024-12-02","2024-12-02","2024-12-02","2024-10-09","2024-05-06","2025-01-14","2024-05-06","2025-10-28","2025-04-11","2025-06-06","2025-06-06","2025-06-06","2025-11-06","2025-01-14","2024-05-06","2025-10-03","2024-03-19","2024-03-19","2025-06-11","2025-06-19","2025-09-12","2025-09-12","2025-09-12","2025-08-08","2025-09-29","2025-10-28","2025-10-28","2024-11-25","2024-02-28","2024-10-09","2024-11-25","2024-11-25","2024-09-19","2024-09-19","2022-11-22","2022-09-30","2022-09-30","2022-09-30","2022-09-16","2022-09-27","2022-06-16"],"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":[["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}