{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George W Gonyer","gend":0,"currentgend":"","add":"184 GREEN POINT RD","city":"BREWER","state":"ME","zip":"04412","dob":"1947-10-25","age":"","mstatus":"","insh":"10000049666","cliId":"","pno":2079892478,"cno":"","email":"opt-out@optout.com","ename":"","eno":"","pphy":"BILLINGS, HANNAH B","ppno":2079455247,"pcpadd":"Penobscot Community Health Center,1012 Union St","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"PENOBSCOT COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"184 GREEN POINT RD","madd2":"","madd3":"","mcity":"BREWER","mstate":"ME","mzip":"04412","pcpfaxno":2079922154,"pcpnpi":1760971683,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4H30FY4XY01","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","E1169","D122","K319","Z1211","R079","K7401","K760","Z23","F3342","L03012","Z87891","Z122","I10","H2512","Z85038","K7030","I491","R319","K7460","M19011","M67813","J432","R918","G4733","M86642","J984","E559","Z125","L02512","F17210","Z0000","Z86010","J479","K709","M7989","R1032","M25511","E119","G4736","M79645","G4739","M5450","F17200","Z0101","H5202","H5211","H52223","H05241","H25012","E7800","Z1329","R944","Z130","J8410","R911","R0981","D128","K5730","K635","K5790"],"date":["2025-11-12","2025-11-12","2024-01-04","2024-01-04","2024-01-04","2025-11-12","2023-12-28","2023-12-28","2025-10-07","2025-11-05","2025-09-04","2023-12-20","2025-07-09","2025-11-12","2023-06-29","2024-01-04","2024-03-08","2025-02-21","2023-02-03","2023-12-28","2023-04-24","2023-04-24","2025-10-20","2025-10-20","2025-09-25","2025-09-23","2024-07-09","2025-11-12","2025-11-12","2025-09-12","2025-07-09","2024-02-15","2024-02-28","2025-08-06","2024-02-28","2025-09-12","2023-01-10","2023-01-09","2024-02-08","2025-09-25","2025-09-17","2025-10-07","2023-02-03","2024-07-16","2023-01-19","2023-01-19","2023-01-19","2023-01-19","2023-01-19","2023-01-19","2023-04-06","2022-12-19","2022-12-19","2024-02-08","2024-06-13","2024-06-13","2022-10-21","2022-06-16","2022-06-16","2022-06-16","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":[["","","TRAZODONE HCL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","OMEGA-3 ACID ETHYL ESTERS","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","METFORMIN HCL ER","","","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":""}]}]}