{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stanley C Tanner","gend":0,"currentgend":"","add":"24 PARSONS WAY","city":"POLAND","state":"ME","zip":"04274","dob":"1941-09-11","age":"","mstatus":"","insh":"10000051428","cliId":"","pno":2079985654,"cno":"","email":"stanosl@aol.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":"24 PARSONS WAY","madd2":"","madd3":"","mcity":"POLAND","mstate":"ME","mzip":"04274","pcpfaxno":2077955727,"pcpnpi":1750862769,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7AH3TC4YR60","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","Z950","G4733","H109","R0609","H6592","H40013","H6523","F329","C44219","R0981","H6121","H906","R051","I442","J309","I509","R9720","L570","X32XXXA","L821","L814","R42","Z136","Z0000","R6889","U071","I080","N289","E7800","R0602","H6993","H938X9","I7121","K589","N189","H6692","H903","L600","L602","Z7689","Z974","Z570","H6590","H6120","L97511","D649","Z0001","M1990"],"date":["2025-01-09","2025-08-13","2025-10-21","2025-09-16","2024-08-13","2025-07-17","2025-01-24","2025-09-02","2025-10-21","2024-03-26","2025-07-17","2025-07-23","2025-09-16","2024-06-27","2025-08-07","2025-01-09","2025-05-07","2023-05-24","2025-10-01","2025-10-01","2025-10-01","2025-10-01","2025-05-07","2023-04-28","2025-09-22","2023-12-11","2023-02-17","2024-09-25","2023-05-02","2023-05-02","2025-10-19","2025-10-20","2024-11-15","2024-06-14","2024-10-02","2024-10-02","2025-08-18","2025-09-02","2023-11-28","2023-11-28","2023-10-04","2025-09-02","2025-09-02","2024-12-02","2025-07-09","2025-09-16","2023-10-04","2022-11-02","2022-11-02"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","TERAZOSIN HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","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":""}]}]}