{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John F Connolly","gend":0,"currentgend":"","add":"1475 GOODWINS MILLS RD","city":"Waterboro","state":"ME","zip":"04087","dob":"1951-04-12","age":"","mstatus":"","insh":"10000048520","cliId":"","pno":2075914437,"cno":2076080236,"email":"Jconnol4@maine.rr.com","ename":"","eno":"","pphy":"TREMBLAY, CHRISTINE","ppno":2076460676,"pcpadd":"WELLS FAMILY PRACTICE,59 MILE RD","pcpcity":"WELLS","pcpstate":"ME","pcpzip":"04090","pcpcounty":"","pcpid":"","pcpname":"WELLS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1475 GOODWINS MILLS RD","madd2":"","madd3":"","mcity":"Waterboro","mstate":"ME","mzip":"04087","pcpfaxno":"","pcpnpi":1457434573,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5U37P35VH60","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","I10","I4891","J479","H5203","H40013","H2513","M1712","G4733","Z96652","Z0000","R7301","K621","Z1211","Z86010","Z621","N401","G8918","Z7901","I480","I340","E782","J209","R042","Z01810","N138","L820","Z789","L538","R58","L718","L821","Z09","Z872","K6289","D6869","I119","R079","N400","J00","R002","R6883","L719","D649","R6889","H02831","H02834","Z87891","R1013","Z79899","I491","R9431","R059","G4730","R4182","L700","H9201","Z713","Z905","L600","M79675","F40243","M25562","D122","D120","D125","D127","D374","H47233","H43391","H25813"],"date":["2024-09-05","2025-10-01","2025-07-15","2025-11-10","2025-10-02","2025-10-02","2025-10-02","2024-05-30","2025-10-20","2025-02-28","2025-04-18","2025-04-14","2023-01-16","2023-01-16","2023-01-16","2023-01-16","2025-11-06","2024-02-27","2024-02-27","2025-10-01","2024-12-31","2025-10-01","2023-12-31","2023-10-27","2023-08-14","2025-11-06","2022-12-28","2022-12-28","2022-12-28","2022-12-28","2022-12-28","2022-12-28","2022-12-28","2022-12-28","2025-09-25","2023-11-10","2023-11-10","2025-07-15","2025-04-14","2025-03-30","2025-07-15","2025-07-15","2023-10-06","2025-07-10","2022-12-30","2025-10-02","2025-10-02","2025-07-15","2024-10-10","2025-07-15","2023-08-19","2023-08-19","2023-08-17","2024-02-27","2024-02-27","2025-04-14","2024-10-10","2022-10-13","2022-10-19","2022-08-25","2022-08-25","2022-08-05","2022-07-19","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2022-06-30","2022-06-30","2022-06-30"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","AZELAIC ACID","","","Select","Select",""],["","","MOXIFLOXACIN HCL","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","CLINDAMYCIN-BENZOYL PEROXIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","DUTASTERIDE-TAMSULOSIN","","","Select","Select",""],["","","ALPRAZOLAM","","","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":""}]}]}