{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Walter A Day","gend":0,"currentgend":"","add":"533 CALDERWOOD NECK ROAD","city":"VINALHAVEN","state":"ME","zip":"04863","dob":"1951-03-24","age":"","mstatus":"","insh":"10000047876","cliId":"","pno":2075932467,"cno":"","email":"wday533@icloud.com","ename":"","eno":"","pphy":"DESMOND, JENNIFER S","ppno":2078634341,"pcpadd":"Islands Community Medical Services\t,15 Medical Center Loop","pcpcity":"Vinalhaven","pcpstate":"ME","pcpzip":"04863","pcpcounty":"","pcpid":"","pcpname":"ISLANDS COMMUNITY MEDICAL SERVICES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"533 CALDERWOOD NECK ROAD","madd2":"","madd3":"","mcity":"VINALHAVEN","mstate":"ME","mzip":"04863","pcpfaxno":2078632737,"pcpnpi":1851480305,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6H99RH4NU43","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9903","M5417","M546","M542","H903","K5100","K3184","M7910","S30861A","E119","E785","Z0001","Z1329","Z0101","E113293","E1121","Z08","Z8589","L821","D229","I10","K219","K449","R143","M25561","M25562","M25531","Q394","S70262A","Z1389","Z1211","D128","K5190","K5730","Z125","K317","Z720","Z87891","K580","L578","J069","H40013","K635","Z86010","I7090","Z1283","L570","H6123","J0190","J329","H6122","E118","S2096XA","S61302D","S61302A","N433","N503"],"date":["2025-09-03","2025-09-03","2025-09-03","2025-09-03","2025-05-15","2025-05-15","2023-03-31","2023-11-27","2024-04-01","2025-07-16","2024-03-18","2024-09-24","2023-02-13","2024-03-19","2025-08-13","2025-07-23","2023-02-22","2024-06-21","2024-06-21","2023-02-22","2025-04-09","2024-03-06","2024-03-06","2024-03-06","2023-05-08","2025-04-09","2022-12-27","2022-12-23","2024-03-27","2022-12-05","2023-06-01","2023-06-01","2024-06-24","2023-06-01","2023-08-16","2023-06-01","2023-04-06","2023-04-06","2023-06-13","2024-06-21","2022-11-03","2025-02-10","2024-06-24","2024-06-24","2024-11-26","2025-07-24","2025-07-24","2025-01-23","2025-02-11","2022-08-10","2022-08-04","2022-08-03","2022-06-22","2022-05-09","2022-04-29","2022-04-12","2022-04-12"],"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":[["","","TAMSULOSIN HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","MESALAMINE","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}