{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Germaine M Gilbert","gend":1,"currentgend":"","add":"701 US RTE 202","city":"NORTH MONMOUTH","state":"ME","zip":"04265","dob":"1957-04-12","age":"","mstatus":"","insh":"10000053925","cliId":"","pno":2079338230,"cno":"","email":"","ename":"","eno":"","pphy":"MURPHY, ROCHELLE S","ppno":2076243800,"pcpadd":"Winthrop Family Medicine,149 Main St","pcpcity":"Winthrop","pcpstate":"ME","pcpzip":"04364","pcpcounty":"","pcpid":"","pcpname":"WINTHROP FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"701 US RTE 202","madd2":"","madd3":"","mcity":"NORTH MONMOUTH","mstate":"ME","mzip":"04265","pcpfaxno":2076243845,"pcpnpi":1245585108,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2KM3UW1HR91","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I5020","I4891","D6800","I340","R69","Z59812","F29","I361","G3184","I447","I5023","J449","S199XXA","R0602","I509","R079","S22069A","R0600","I214","S32039A","F03B2","I110","I4819","I428","R112","J90","J9811","R918","I429","I081","F23","J811","R059","I517","Z91128","F419","Z602","Z596","I4820","F17210","I5043","D680","R7401","D649","I50810","S3991XA","R109","R601","I501","I499","R188","K828","E878","Z20822","K810","I252","R9431","K819","I10","A419","K8020","R1011","K5790","R1010","R000"],"date":["2023-09-07","2025-10-16","2023-08-09","2023-08-09","2025-09-08","2025-09-08","2025-10-20","2023-08-07","2025-10-28","2025-10-16","2023-08-07","2023-08-07","2024-12-17","2023-08-05","2023-08-05","2023-08-05","2024-12-17","2023-08-06","2023-08-06","2024-12-17","2025-11-02","2023-01-04","2023-01-04","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2025-09-10","2023-08-05","2023-08-05","2023-08-05","2023-01-04","2023-01-04","2023-01-04","2023-01-04","2023-01-03","2023-01-03","2022-05-03","2022-05-01","2022-04-29","2022-04-29","2022-05-04","2022-04-30","2022-04-30","2022-04-30","2022-04-28","2022-04-28","2022-04-28","2022-04-28","2022-04-28","2022-04-28","2022-04-18","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-14","2022-04-15","2022-04-13","2022-04-04","2022-04-04","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":[["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","DIGOXIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","DICYCLOMINE HCL","","","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":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}