{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David S Olson","gend":0,"currentgend":"","add":"1SADDLE LANE","city":"GORHAM","state":"ME","zip":"04038","dob":"1951-06-24","age":"","mstatus":"","insh":"10000051993","cliId":"","pno":2077129949,"cno":"","email":"mainesurfdog@gmail.com","ename":"","eno":"","pphy":"SCONTRAS, JENNIFER","ppno":"","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1SADDLE LANE","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":2075231135,"pcpnpi":1659908101,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8TM6HY3FN58","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":["M47816","E7849","I2510","I10","I445","I4510","E871","Z7184","M810","S76219A","R7989","Z0100","M79641","M25561","R7303","I441","I491","M5136","I5189","I452","C44719","R748","R0609","L570","Z85828","D225","L814","L821","R6889","M25562","G8929","Z23","I25110","E785","I4589","E782","Z950","R918","H35373","I479","M5450","S62634A","M19041","B351","H43393","N401","H26493","H538","R42","I493","I4720","R008","L578","D492","L820","R208","D1801","C609","I498","H43391","N138","M1712","H43813","I517","M65321","H43811","H35371","Z13820"],"date":["2025-04-28","2023-10-05","2025-09-05","2025-09-05","2025-07-09","2025-07-09","2025-06-30","2025-05-20","2025-05-19","2023-12-21","2025-08-18","2025-06-02","2023-12-01","2023-10-03","2025-05-19","2025-09-05","2025-05-16","2024-01-09","2025-08-26","2025-09-05","2023-10-24","2024-01-11","2025-08-26","2025-05-15","2025-05-15","2025-05-15","2025-05-15","2025-05-15","2023-12-26","2023-10-03","2023-10-03","2025-09-02","2025-02-24","2025-09-05","2025-09-05","2025-03-04","2025-10-03","2025-09-05","2024-12-20","2024-08-23","2023-06-29","2025-04-02","2025-04-02","2024-12-23","2024-10-17","2025-08-14","2023-04-24","2023-03-24","2025-02-18","2024-08-23","2024-08-23","2024-08-23","2023-05-11","2023-05-11","2024-05-16","2024-05-16","2024-05-16","2024-08-08","2025-01-13","2024-12-04","2025-08-14","2023-07-06","2024-10-17","2025-08-19","2024-11-22","2024-12-04","2024-12-04","2025-04-28"],"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":[["","","OLMESARTAN MEDOXOMIL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ACETAZOLAMIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TESTOSTERONE CYPIONATE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","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":""}]}]}