{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald Allain","gend":0,"currentgend":"","add":"53 WHITES POINT ROAD","city":"STANDISH","state":"ME","zip":"04084","dob":"1943-10-19","age":"","mstatus":"","insh":"10000046802","cliId":"","pno":2078931784,"cno":"","email":"deallain@aol.com","ename":"","eno":"","pphy":"DOBIESKI, STEVEN T","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"53 WHITES POINT ROAD","madd2":"","madd3":"","mcity":"STANDISH","mstate":"ME","mzip":"04084","pcpfaxno":2078741483,"pcpnpi":1942279617,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4GT1AE5QY12","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4821","J90","J9811","M25551","M25561","M25562","E1159","R590","E1142","L851","B351","L600","E1149","S22079D","E1122","S22070D","S22078D","L89893","M47816","L570","R238","M5450","H903","I5030","S22078A","Z0000","M5416","M1611","M25651","R5383","L89892","G8929","C8298","Z8781","I4891","K5900","U071","G4733","G4737","S22000A","H5789","N179","R300","S0990XA","S199XXA","Z7901","E1169","C8224","I480","I4811","S32010G","S22089D","M546","S299XXA","L02612","S22070A","H35361","Z0101","L821","Z719","Z872","I2510","R846","R053","Z951","R051","Z0001","R6889","M5126","M4316","R600","L89899","S22079A","I872","Z125","E7800","C8334","S3992XA","I739","M79674","M79675","L84","Z1211","Z0100","S39012D","M5459","M5430","M5116","M4726","S90122A"],"date":["2025-10-29","2025-08-27","2025-03-14","2023-12-12","2023-12-12","2023-12-12","2024-09-10","2025-05-07","2025-07-17","2025-11-20","2025-11-20","2025-05-15","2025-11-20","2024-11-27","2025-01-30","2024-11-27","2025-02-02","2024-09-10","2023-01-30","2025-09-03","2023-04-05","2024-10-05","2023-11-02","2025-09-08","2024-10-05","2025-05-29","2023-03-23","2023-03-23","2023-03-23","2024-03-19","2024-09-25","2023-06-20","2025-05-29","2024-11-27","2025-05-21","2024-10-11","2024-10-11","2025-03-27","2024-06-26","2024-10-07","2024-04-22","2024-11-06","2024-10-25","2024-10-05","2024-10-05","2023-12-15","2023-10-31","2025-08-27","2025-03-06","2025-09-03","2023-01-30","2024-11-27","2024-10-05","2024-10-05","2024-04-02","2024-10-06","2024-03-05","2025-03-06","2025-09-03","2025-09-03","2025-09-03","2025-08-27","2024-01-23","2024-02-06","2025-05-08","2023-12-15","2024-03-19","2024-10-29","2023-01-30","2023-01-30","2024-09-17","2024-09-10","2024-10-22","2024-10-22","2025-06-04","2025-05-08","2025-05-07","2024-10-15","2024-09-16","2022-10-04","2022-10-04","2022-10-04","2022-09-12","2022-08-26","2022-08-17","2022-08-09","2022-08-31","2022-08-31","2022-08-31","2022-08-02"],"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":[["","","METFORMIN HCL","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","TOBRAMYCIN","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","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":""}]}]}