{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Miles T Haskell","gend":0,"currentgend":"","add":"78 LOVEITTS FIELD RD","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1948-06-20","age":"","mstatus":"","insh":"10000050312","cliId":"","pno":2077672062,"cno":"","email":"mhaskell@maine.rr.com","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":2077745816,"pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2077762359,"add2":"","add3":"","madd1":"78 LOVEITTS FIELD RD","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AJ4N47NM94","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25552","Z472","I2510","I10","E785","R899","Z471","Z96642","R799","I951","M12552","M87052","M1652","E039","E7800","Z1211","D122","Z860101","D123","M1612","J209","N1832","N400","Z0000","Z0001","R55","R42","Z01818","R7989","N281","Q6589","L4059","M109","Z79899","M0609","M25559","I129","N179","R079","M84459S","R008","Z23","M1A09X0","M1A09X1","R002","T8484XA","G8929","M061","S72002S","S72002D","M810","G8918","S72002A","M549","R6889"],"date":["2023-07-12","2023-06-29","2025-05-16","2025-05-16","2024-03-21","2023-07-17","2023-09-27","2023-09-27","2023-07-17","2025-10-27","2023-07-31","2023-07-31","2023-07-31","2024-09-16","2024-09-16","2025-01-29","2025-01-29","2025-01-29","2025-01-29","2023-07-31","2024-01-06","2024-09-16","2023-09-07","2023-09-11","2024-09-16","2025-10-27","2025-10-27","2023-07-17","2024-11-12","2022-12-01","2023-07-12","2023-05-02","2023-05-02","2023-05-02","2023-07-17","2023-07-12","2023-07-31","2022-12-01","2025-10-27","2022-11-01","2022-10-06","2022-10-13","2022-08-25","2022-09-01","2022-09-01","2022-08-01","2022-07-21","2022-07-21","2022-07-21","2022-06-29","2022-05-03","2021-10-11","2021-12-09","2022-01-11","2022-01-15"],"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":[["","","CARVEDILOL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","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":""}]}]}