{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gordon R Brasslett","gend":0,"currentgend":"","add":"38 BRASLEY AVENUE APT 13","city":"BANGOR","state":"ME","zip":"04401","dob":"1950-12-08","age":"","mstatus":"","insh":"10000047235","cliId":"","pno":2079443031,"cno":2079428712,"email":"declined@080325.com","ename":"","eno":"","pphy":"BARTLETT, TERESA M","ppno":2079073300,"pcpadd":"St Joseph Healthcare Internal Medicine,900 Broadway","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"38 BRASLEY AVENUE APT 13","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":2079071923,"pcpnpi":1386980829,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8ET1N53WC24","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z08","H6690","C109","G894","R1031","C090","H2511","C099","H7191","R1310","Z931","D500","D649","E8342","I517","F17200","M5416","K4090","K117","Z87891","I452","H7391","H6981","I7140","I708","D692","H60501","H6501","Z20822","Z85818","Z923","Z4659","Z09","I25110","I7143","E1169","E785","E611","M5450","Z98890","I7133","I723","Z0000","E119","J392","M25552","Z452","C801","R6330","E1165","Z85810","Z431","C108","I10","K635","R490","T8189XA","Z5111","M792","R531","R5383","Z510","L598","Y842","R042","Z79899","N281","I97618","R590","F17210","M5136","M47816","M4316","H2512","I77819","I2510","I119","E1136","F3342","K0381","Z1384","E7800","H25011","H2513","H43813","Z0101","H524","I25118"],"date":["2025-03-20","2023-06-30","2024-11-12","2024-10-07","2025-01-30","2024-07-29","2022-12-07","2025-08-26","2023-09-14","2024-09-17","2024-04-09","2025-07-07","2025-08-26","2025-07-18","2025-07-09","2024-03-19","2023-05-24","2025-02-11","2024-10-01","2024-05-10","2025-07-09","2023-09-05","2023-08-01","2024-10-04","2024-02-18","2025-08-26","2023-06-20","2023-06-20","2023-09-05","2025-06-26","2024-09-12","2024-03-29","2025-07-18","2024-02-29","2024-03-21","2025-08-26","2025-05-05","2023-03-02","2023-03-02","2024-03-21","2024-02-13","2024-02-13","2025-06-03","2025-01-08","2025-06-26","2023-02-02","2024-02-29","2024-02-29","2024-09-17","2024-10-23","2024-10-28","2024-03-29","2024-11-21","2025-02-25","2022-11-01","2022-11-01","2024-02-18","2024-03-04","2024-12-20","2025-07-07","2025-07-07","2024-04-01","2025-01-17","2025-01-17","2023-09-05","2024-08-13","2025-07-08","2024-02-18","2024-02-06","2024-09-12","2023-02-02","2023-02-02","2023-02-02","2022-09-28","2022-07-14","2022-07-14","2022-07-06","2022-07-06","2022-07-06","2022-05-18","2022-05-18","2022-06-09","2022-06-09","2022-06-09","2022-06-09","2022-04-20","2022-04-20","2022-04-22"],"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":[["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","PILOCARPINE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","SODIUM FLUORIDE-POTASSIUM NITR","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","LIDOCAINE-PRILOCAINE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","NAPROXEN","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"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":""}]}]}