{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ralph C Wyman","gend":0,"currentgend":"","add":"29 HUARD AVENUE","city":"AUBURN","state":"ME","zip":"04210","dob":"1951-07-06","age":"","mstatus":"","insh":"10000050318","cliId":"","pno":2075764602,"cno":"","email":"budthebodyguy@yahoo.com","ename":"","eno":"","pphy":"BEGGS, ALEX W","ppno":2077955700,"pcpadd":"12 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407676","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1893","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04211","pcpfaxno":2077955727,"pcpnpi":1750862769,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8D70YE5WW33","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M19011","M7541","M19012","M7542","R519","J449","I10","G43909","G453","M25511","M25512","L281","L918","L538","R6889","E119","U071","R7303","D509","L570","L0291","Z8501","G64","E785","Z0000","E8351","Z98890","Z09","D649","H31103","Z125"],"date":["2023-11-14","2024-08-02","2023-11-14","2025-02-14","2024-12-20","2025-10-27","2025-06-06","2025-01-30","2024-12-11","2024-01-09","2024-01-09","2024-12-02","2024-12-02","2024-12-02","2023-05-25","2024-06-10","2023-02-23","2023-08-03","2024-12-05","2024-10-29","2023-05-17","2023-08-03","2023-08-03","2024-12-05","2025-10-27","2023-02-21","2025-02-14","2025-10-10","2024-05-28","2025-06-12","2022-08-23"],"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":[["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ADACEL TDAP","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}