{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard W Pierce","gend":0,"currentgend":"","add":"148 BREAKWATER DR UNIT 310","city":"South Portland","state":"ME","zip":"04106","dob":"1950-09-16","age":"","mstatus":"","insh":"10000052071","cliId":"","pno":2076532723,"cno":"","email":"richardrachelpierce@gmail.com","ename":"","eno":"","pphy":"CATHCART, CHARLES","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 700","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"148 BREAKWATER DR","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":2078741483,"pcpnpi":1861461535,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9FQ8R45HG26","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L570","C73","E890","R911","R0600","I77810","D492","Z85828","L219","C3412","J069","H903","Z23","E1169","E1136","I10","L309","J029","S80869A","R1310","R490","Z6825","E7800","E1159","R600","Z1211","D128","K5730","H9313","R051","J189","Z03818","K222","K219","E119","Z85850","N5089","C7800","I898","H26491","D3141","Z0001","B079","I861","N433","R918","Z0000","C3490","R590","Z0100","M0609","Z79899","E0789","K224","E042","E569","H04129","C4491","H6506","R070","L989","I639","E041","I351","R002","Z8639","R0982","R6889","R202","M4802","M5030","Q7649","M542","M549","M4722","E782","M436","M62838","M629","M5412","Z1152","U071"],"date":["2025-04-21","2025-07-23","2025-10-23","2024-12-04","2024-10-31","2025-10-30","2024-10-22","2025-04-21","2025-04-21","2024-12-20","2024-01-26","2025-08-07","2025-10-24","2023-10-13","2023-10-13","2024-12-14","2023-10-13","2024-04-14","2023-07-12","2024-11-22","2024-09-10","2024-04-13","2024-10-16","2025-06-20","2023-12-29","2025-01-20","2025-01-20","2025-01-20","2024-09-10","2025-05-11","2025-05-11","2025-05-11","2023-12-28","2024-12-04","2024-12-04","2024-12-04","2025-10-08","2024-10-10","2023-05-23","2023-12-13","2023-12-13","2024-10-16","2024-10-16","2025-10-08","2025-10-08","2025-07-21","2025-10-24","2024-12-04","2023-05-23","2024-11-26","2025-10-28","2025-10-28","2023-05-26","2024-11-22","2023-05-08","2023-02-03","2023-02-03","2024-02-26","2025-08-28","2023-03-20","2025-02-12","2024-02-11","2023-05-23","2025-10-30","2025-11-17","2023-08-14","2023-03-10","2023-01-01","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-06-07","2022-06-07","2022-06-07","2022-05-24","2022-04-22","2022-04-22","2022-04-22","2022-03-16","2021-11-08","2022-01-13"],"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":[["","","METFORMIN HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PREDNISONE","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":[]}},{"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":""}]}]}