{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lester H Darigan","gend":0,"currentgend":"","add":"10 BERGERON LN","city":"Biddeford","state":"ME","zip":"04005","dob":"1946-03-08","age":"","mstatus":"","insh":"10000051528","cliId":"","pno":2075904229,"cno":"","email":"lmdarigan68@gmail.com","ename":"","eno":"","pphy":"POLLARD, DOUGLAS C","ppno":2073513530,"pcpadd":"York Hospital Internal Medicine of York,12 Hospital Dr Ste B","pcpcity":"York","pcpstate":"ME","pcpzip":"03909","pcpcounty":"","pcpid":"","pcpname":"YORK HOSPITAL INTERNAL MEDICINE OF YORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 BERGERON LN","madd2":"","madd3":"","mcity":"Biddeford","mstate":"ME","mzip":"04005","pcpfaxno":2073513574,"pcpnpi":1710969803,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4GR7PK6FR45","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1065","E538","D649","S90222A","K2270","E611","B181","K449","K3189","Z9641","N200","D500","C7A8","K2940","K31A0","B351","M79674","M79675","E1021","K2950","K31A19","Z0000","K824","Z85020","Z0101","E103293","K317","R6889","E785","I10","K7689","S91209A","Z860101","D123","R935","Z1211","M2041","M2042","R011","K769","Z860100","K635","K5730","H524","L600","Z794","R932","B1920","E164","D508","J069","E109","Z86010","K5140","T85614A","Y848","Y92009","E119"],"date":["2025-10-29","2025-10-23","2025-10-16","2023-10-18","2023-10-02","2023-06-12","2025-09-23","2024-09-12","2024-09-12","2025-10-29","2023-07-14","2024-12-26","2023-05-12","2023-04-19","2023-04-19","2025-10-27","2025-10-27","2025-10-27","2025-08-16","2023-04-19","2023-04-19","2025-09-11","2024-12-31","2024-09-12","2025-09-24","2025-09-24","2023-09-07","2023-10-16","2025-06-02","2025-06-02","2024-02-15","2023-09-12","2025-08-06","2025-08-06","2024-03-04","2025-08-06","2023-07-19","2023-07-19","2025-09-11","2024-06-13","2025-08-06","2025-08-06","2025-08-06","2023-03-28","2025-04-28","2024-08-21","2024-02-26","2024-06-21","2023-10-02","2023-10-02","2022-11-23","2022-08-10","2022-09-02","2022-09-02","2022-07-23","2022-07-23","2022-07-23","2022-07-23"],"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":[["","","CONTOUR NEXT TEST STRIP","","","Select","Select",""],["","","GVOKE HYPOPEN 1-PACK","","","Select","Select",""],["","","HUMALOG","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","GVOKE HYPOPEN 2-PACK","","","Select","Select",""],["","","INSULIN LISPRO","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CONTOUR NEXT EZ","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","ULTICARE PEN NEEDLE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}