{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David J Tebbets","gend":0,"currentgend":"","add":"947 ROYALSBOROUGH RD","city":"DURHAM","state":"ME","zip":"04222","dob":"1950-03-08","age":"","mstatus":"","insh":"10000051534","cliId":"","pno":2073532441,"cno":2073300197,"email":"tebbetsam@gmail.com","ename":"","eno":"","pphy":"TAN, EDWIN V","ppno":2073303950,"pcpadd":"PO BOX 7291,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"AUBURN MEDICAL ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"947 ROYALSBOROUGH RD","madd2":"","madd3":"","mcity":"DURHAM","mstate":"ME","mzip":"04222","pcpfaxno":2073303955,"pcpnpi":1629074240,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4VU9Q82DH29","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D492","M160","M25751","M1711","H1045","I10","I493","Z8249","Z01810","L570","D469","G4733","Z01818","D2222","L98499","D649","D638","M25551","I5189","E785","H04123","M25561","Z1211","G8929","G609","L97522","L97529","Z98890","N390","L97521","N3001","B351","Z4800","Z471","R6889","E6601","Z6841","N200","N281","K5730","H26492","L84","E11621","L089","S5012XA","S50812A","X58XXXA","L98491","N3000","Z0000","G5793","M79674","M79675","D120","D122","R059","R509","H26493","H16223","I110","Z6838","Z8546","H26491","M1611","E66813","K5900","K219","D0462","Z96641","Z9181","Z87440","Z9079","N3289","Z09","R42","M2060","Z23","G6289","I361","I517","I5030","L03032","G600","S91102D","G5791","L400","L219","Z85828","Z125","H40013","H6123","L4050","D890","C61","J189","M19041","R531","S30860A","W57XXXA","E876","Z20822","Z87891","E878","R918","R519","G629"],"date":["2023-12-13","2023-12-07","2023-12-07","2023-12-07","2025-06-09","2025-09-10","2025-09-10","2025-09-10","2024-01-29","2024-12-04","2025-08-04","2025-09-10","2024-01-26","2023-12-13","2023-12-13","2023-09-09","2024-06-11","2023-12-07","2025-09-10","2025-06-06","2025-07-16","2023-10-19","2024-07-18","2023-10-19","2024-09-18","2024-09-18","2024-09-18","2024-05-03","2024-09-16","2025-02-11","2024-10-24","2025-04-14","2024-10-02","2024-04-11","2024-01-26","2024-08-28","2024-02-15","2024-09-16","2024-09-16","2024-09-16","2025-09-03","2024-04-16","2024-08-07","2024-02-23","2023-06-11","2023-06-11","2023-06-11","2024-06-26","2024-07-29","2025-01-08","2025-11-18","2024-07-02","2024-07-02","2024-07-18","2024-07-18","2024-07-29","2024-07-29","2024-07-15","2024-07-15","2024-05-28","2024-08-28","2024-08-29","2025-09-17","2024-02-15","2024-12-04","2024-12-04","2024-02-15","2022-12-29","2024-02-29","2024-02-02","2024-10-24","2024-10-24","2024-10-24","2024-03-06","2024-01-31","2024-10-08","2024-01-17","2024-10-08","2024-01-29","2024-01-29","2024-01-29","2024-02-28","2024-02-28","2024-04-03","2024-04-03","2022-12-07","2022-12-07","2022-12-07","2024-11-25","2025-08-01","2022-11-23","2022-11-23","2022-08-29","2022-08-29","2022-06-20","2022-08-04","2022-06-12","2022-05-14","2022-05-14","2022-06-12","2022-06-12","2022-06-12","2022-06-20","2022-06-12","2022-06-12","2022-04-04"],"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":[["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","MINOCYCLINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}