{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John S Diaz","gend":0,"currentgend":"","add":"26 WEST DARTMOUTH ST","city":"AUBURN","state":"ME","zip":"04210","dob":"1950-03-20","age":"","mstatus":"","insh":"10000051340","cliId":"","pno":2077834019,"cno":"","email":"j.s.d.60@hotmail.com","ename":"","eno":"","pphy":"TREMIS, MARIE ALEXANDRIA","ppno":2077955750,"pcpadd":"76 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"26 WEST DARTMOUTH ST","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":"","pcpnpi":1285110023,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4C59MP0HJ11","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R202","K602","L918","R251","C7A8","R197","K649","I10","K6289","R1084","G250","N401","R9431","J40","R238","L280","R059","D3A012","M6289","Z981","Z4682","C7A012","R9720","M6208","C7A1","R209","K219","K5730","K648","D3A00","D3A8","G5613","R109","K56600","R1903","R519","M7989","Z20822","Z79899","Z7951","R159","R569","M9903","M4727","M5451","M25512","M5412","Z0101","H35372","R918","R079","M549","K429","M519","E876","R058","E0590","R978","N138","F259","G252","C7A00","K760","K639","R200","J069","M5137","M47817","C7A011","M50321","R52","M25511","M5410","Z86010","R9389","C172","K5289","M50322","J9809","H2513","H43812","G8918","Z9049","G893","M4802","M5011","M4722","M4312","K5900","H43822","R6889","M5450","M9900","M9901","M9902","K529","I4510","M47816","M4187","M546"],"date":["2025-07-18","2025-05-12","2025-05-12","2025-01-22","2025-04-21","2025-10-17","2025-02-14","2024-08-16","2025-06-09","2022-12-22","2025-05-09","2025-09-19","2022-12-22","2024-10-15","2023-03-07","2023-03-07","2024-11-26","2023-01-23","2025-09-02","2023-01-24","2023-01-24","2025-10-20","2025-01-22","2024-09-10","2025-04-21","2025-04-29","2025-02-05","2025-02-05","2025-02-05","2023-01-20","2025-10-24","2025-10-28","2023-02-06","2022-12-23","2022-12-23","2022-12-22","2022-12-22","2022-12-22","2023-06-23","2022-12-22","2025-09-09","2023-08-28","2023-01-03","2023-01-03","2023-01-03","2025-10-15","2025-03-12","2025-02-10","2025-02-10","2022-12-22","2022-12-22","2022-12-22","2022-12-22","2024-06-10","2024-07-08","2022-12-08","2024-08-16","2023-06-23","2023-01-23","2023-08-31","2023-08-31","2023-12-22","2023-01-20","2023-01-03","2025-05-09","2025-01-08","2024-06-10","2024-06-10","2025-10-24","2025-05-28","2025-05-28","2025-02-14","2025-02-14","2023-01-12","2023-01-12","2023-04-28","2023-05-05","2025-09-17","2024-11-06","2024-04-15","2024-04-15","2023-02-06","2023-02-06","2023-02-14","2025-03-12","2025-03-12","2025-03-12","2025-03-12","2022-12-28","2022-11-14","2022-11-14","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-11","2022-08-12","2022-08-29","2022-08-29","2022-08-29"],"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":[["","","FINASTERIDE","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","CARBAMAZEPINE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PEG3350-SOD SUL-NACL-KCL-ASB-C","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PREVALITE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CHOLESTYRAMINE LIGHT","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}