{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William K Sanborn","gend":0,"currentgend":"","add":"3 HUTCHINS COVE DRIVE","city":"KITTERY","state":"ME","zip":"03904","dob":"1951-09-29","age":"","mstatus":"","insh":"10000050216","cliId":"","pno":2073674212,"cno":"","email":"sanborn5@aol.com","ename":"","eno":"","pphy":"BRADEN, TREVOR","ppno":2074394430,"pcpadd":"KITTERY FAMILY PRACTICE,35 WALKER ST","pcpcity":"KITTERY","pcpstate":"ME","pcpzip":"03904","pcpcounty":"","pcpid":"","pcpname":"KITTERY FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 SNAP HOOK DR","madd2":"","madd3":"","mcity":"York","mstate":"ME","mzip":"03909","pcpfaxno":2074390968,"pcpnpi":1588739866,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1MF8KJ7HG30","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25561","M1711","J0110","Z23","S3609XA","R338","N400","M79662","Z043","M25512","S199XXA","M47812","M75122","I2510","K449","N200","S299XXA","S46011A","S46012A","W11XXXA","Y929","M542","I10","Z0000","R079","R109","I959","M25519","R188","R1084","S40012A","R339","R0989","J9811","R0600","S36032A","K661","J90","R918","I82812","M7989","Z9081","R9720","I480","S46912A","N402","R69","J209","M7582","M25412","M19012","Z48812","S60222A","S36032D","R6889","S3600XA","K469","E861","M79603","R531","N401","R310","S40862A"],"date":["2025-07-11","2025-07-11","2022-11-29","2024-09-19","2023-07-07","2023-07-07","2023-07-07","2023-07-07","2023-06-28","2023-06-28","2023-06-28","2023-06-28","2024-05-30","2023-07-02","2023-06-28","2023-07-02","2023-06-28","2023-08-31","2023-08-31","2023-08-31","2023-08-31","2023-12-03","2023-07-10","2025-06-13","2023-07-02","2023-07-02","2023-07-02","2023-08-31","2023-07-07","2023-07-02","2023-06-28","2025-08-06","2023-07-05","2023-07-04","2023-07-04","2023-07-02","2023-07-02","2023-07-05","2023-07-05","2023-07-05","2023-07-05","2025-01-13","2025-07-14","2023-05-25","2024-01-31","2025-07-14","2024-10-17","2024-10-17","2024-01-31","2024-01-31","2024-01-31","2023-07-19","2023-06-28","2023-07-10","2022-12-31","2023-07-02","2023-07-02","2023-07-02","2024-01-15","2024-01-15","2022-11-09","2022-09-13","2022-08-24"],"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",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","ELIQUIS","","","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":""}]}]}