{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Fateh S Azzam","gend":0,"currentgend":"","add":"106 HEALD ROAD","city":"GEORGETOWN","state":"ME","zip":"04548","dob":"1950-06-20","age":"","mstatus":"","insh":"10000050844","cliId":"","pno":2072086800,"cno":"","email":"FATEHAZZAM@GMAIL.COM","ename":"","eno":"","pphy":"SOMMER, JOHN E","ppno":2077984400,"pcpadd":"Martins Point Health Care,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 249","madd2":"","madd3":"","mcity":"GEORGETOWN","mstate":"ME","mzip":"04548","pcpfaxno":2078287850,"pcpnpi":1275732364,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4C70FR5KJ03","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","I319","R079","G459","Z23","M2042","J45909","D225","R0600","I700","I517","B354","Z0000","R509","J90","R6889","Z1211","R600","I082","I77810","I7120","D171","I3139","D492","G4733","I4710","I440","I491","H532","R222","R0789","R911","Z720","M5489","R001","Z20822","Z125","E7800","N179","L820","Z130","Z86010","K635","K641","E785","Z6830","M79675","Z87891","S61211A","J9811","R918","K5790","K5900","K7689","M7989","M79672","R109","Z8709","D649","S92522A","I351","I6529","K219","D1730","D122","Z96692","H26492","R262","M7740","B351","I712","Z8619","Z961"],"date":["2025-11-12","2023-10-25","2023-09-13","2025-10-15","2024-10-08","2025-10-28","2025-11-12","2025-10-29","2023-09-12","2023-09-12","2023-11-08","2024-03-04","2024-10-08","2023-09-25","2024-03-22","2023-06-18","2023-06-28","2024-10-01","2023-10-10","2023-10-10","2024-03-06","2025-11-12","2023-11-08","2025-10-29","2025-11-06","2025-10-16","2025-10-16","2025-10-16","2025-10-31","2025-11-12","2023-10-25","2023-09-29","2025-11-06","2023-09-12","2023-09-12","2023-09-12","2024-10-01","2024-04-15","2023-08-02","2024-10-29","2023-09-22","2023-06-28","2023-06-28","2023-06-28","2025-11-12","2023-07-24","2025-10-06","2025-10-10","2024-02-26","2023-09-29","2024-03-22","2023-09-29","2023-09-29","2023-09-29","2023-07-10","2025-10-10","2023-09-25","2023-09-25","2023-08-02","2025-10-10","2025-10-10","2025-10-31","2023-06-28","2025-03-10","2023-06-28","2025-10-10","2025-05-21","2025-10-15","2022-11-16","2022-11-16","2022-09-26","2022-09-29","2022-08-19"],"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":[["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","METHYLPHENIDATE HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","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":""}]}]}