{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald H Bridge","gend":0,"currentgend":"","add":"58 BUFFUM ROAD","city":"NORTH BERWICK","state":"ME","zip":"03906","dob":"1936-04-21","age":"","mstatus":"","insh":"10000053557","cliId":"","pno":2076769335,"cno":"","email":"","ename":"","eno":"","pphy":"EATON, JEFFREY","ppno":2073849212,"pcpadd":"Great Works Family Practice,57 Portland St","pcpcity":"South Berwick","pcpstate":"ME","pcpzip":"03908","pcpcounty":"","pcpid":"","pcpname":"GREAT WORKS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"58 BUFFUM ROAD","madd2":"","madd3":"","mcity":"NORTH BERWICK","mstate":"ME","mzip":"03906","pcpfaxno":2073842008,"pcpnpi":1700835436,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8PV6RQ1FX53","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","D7589","M5416","I4891","R9431","M4807","M4727","R9439","Z01810","Z950","R0609","M5136","R0600","M48062","M5450","R0602","K5900","R1030","R5383","M47817","M1000","R079","I480","I25119","M961","I2510","R0789","I3139","R21","M47816","Z4789","Z98890","M4316","M4186","M4696","R100","M9905","J9811","Z01818","R4189","Z23","I10","R000","Z139","R4689"],"date":["2025-06-06","2025-06-06","2025-09-10","2025-08-22","2025-08-22","2023-11-10","2023-11-10","2024-03-14","2025-01-17","2024-03-14","2025-08-21","2024-06-18","2024-10-08","2025-08-15","2024-06-10","2025-08-21","2025-08-21","2025-08-21","2025-08-21","2023-08-07","2023-08-07","2024-03-07","2024-03-07","2024-04-30","2025-08-15","2024-03-14","2024-03-24","2024-04-30","2023-10-23","2025-02-24","2025-02-27","2023-09-29","2023-09-29","2023-09-29","2025-02-24","2025-08-21","2024-06-10","2024-03-24","2025-01-29","2022-12-22","2023-10-06","2022-11-03","2022-11-03","2022-11-03","2022-08-11"],"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":[["","","NITROGLYCERIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","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":""}]}]}