{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wayne W White","gend":0,"currentgend":"","add":"60 PREBLE AVE","city":"ANSON","state":"ME","zip":"04911","dob":"1952-02-14","age":"","mstatus":"","insh":"10000052174","cliId":"","pno":2073128863,"cno":"","email":"Scaleflyer14@yahoo.com","ename":"","eno":"","pphy":"DAWICZYK, MICHELLE","ppno":2078731181,"pcpadd":"Waterville Family Practice,31 Front st","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"WATERVILLE FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"60 PREBLE AVE","madd2":"","madd3":"","mcity":"ANSON","mstate":"ME","mzip":"04911","pcpfaxno":2078731186,"pcpnpi":1942550058,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6VV5QD0HK63","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D509","J069","I499","M79602","M542","V4940XD","D500","R791","I10","I517","I253","I4891","Z139","Z0000","Z1389","Z1331","I200","N400","Z006","R5381","V892XXS","I2510","R9341","K810","N320","R932","R1011","S59912S","R29898","K828","K838","R109","I480","D649","I340","Z95818","E83110","M25532","E785","K219","I080","R413","I350","R931","I25118","T1490XA","M19022","M1812","I25110","K8001","K82A1","K8000","M7712","K224","K821","S0990XA","J449","M546","M9900","M9901","M9902","R509","Z743","T07XXXA","K2270","S3991XA","M62838","V892XXD","S59912D","V892XXA","R079","I4710","I4720","R008"],"date":["2025-07-15","2025-02-03","2025-02-03","2025-07-15","2025-10-02","2025-07-15","2025-10-06","2025-02-18","2025-06-30","2025-03-24","2023-09-29","2023-10-02","2025-01-22","2025-01-22","2025-01-22","2025-01-22","2025-02-18","2023-05-04","2025-01-30","2025-02-03","2025-10-28","2025-03-03","2023-09-28","2023-10-10","2023-09-28","2023-09-29","2023-09-29","2025-10-28","2025-10-28","2023-09-29","2023-09-29","2023-09-29","2025-07-17","2025-02-19","2025-03-24","2025-03-24","2025-07-17","2025-06-30","2025-02-26","2025-02-14","2025-01-30","2025-10-01","2025-02-03","2025-02-14","2025-02-14","2025-06-30","2025-06-30","2025-06-30","2025-02-14","2023-10-01","2023-10-01","2023-10-02","2025-10-08","2025-02-14","2023-10-02","2025-06-23","2023-10-02","2025-02-18","2025-02-18","2025-02-18","2025-02-18","2023-09-28","2023-09-28","2025-06-23","2023-09-26","2025-06-23","2025-09-16","2025-09-16","2025-09-16","2025-06-30","2025-02-14","2025-02-28","2025-02-28","2025-02-28"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","RANOLAZINE ER","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}