{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Burton R Labelle","gend":0,"currentgend":"","add":"15 WEST LOOP RD","city":"BIDDEFORD","state":"ME","zip":"04005","dob":"1948-11-13","age":"","mstatus":"","insh":"10000054024","cliId":"","pno":2074506136,"cno":"","email":"Wargmr13@gmail.com","ename":"","eno":"","pphy":"HUOT, BRAD R","ppno":2078282402,"pcpadd":"PO BOX 9746,MARTINS POINT HEALTHCARE","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":"15 WEST LOOP RD","madd2":"","madd3":"","mcity":"BIDDEFORD","mstate":"ME","mzip":"04005","pcpfaxno":2078282425,"pcpnpi":1891866372,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5YM8R63HC58","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5137","M47817","M67431","M25531","H43811","H4311","M25512","H538","R531","R6889","M79662","S86012S","Z1211","R09A2","J383","H43393","R9720","E1142","N401","N200","R319","R310","N138","M7662","M79672","D2262","L578","L821","L814","H6123","M9903","M4726","M5450","M9904","E1169","R39198","R55","S01511A","Z87891","M19012","E785","I10","E669","K5730","K644","M4727","M533","S61432A","L089","Z23","J069","H33001","H33021","H43813","E113593","M7661","G8929","M62830","E782","N400","E039","M7742","H35721","L570","M7532","M79671","M722","D229","T1490XA","K648","S6992XA","M66872","D239","L738","L820","D485"],"date":["2024-08-15","2024-08-15","2023-04-11","2023-04-03","2024-11-12","2024-06-12","2023-10-02","2025-09-03","2025-08-13","2023-01-17","2025-08-06","2025-08-06","2024-02-07","2025-03-14","2025-03-14","2025-03-27","2025-09-04","2025-09-02","2025-07-11","2023-06-29","2023-06-29","2025-07-11","2025-07-11","2025-06-11","2025-06-11","2024-11-19","2024-11-19","2024-11-19","2024-11-19","2024-07-29","2023-09-19","2023-07-19","2024-08-15","2023-09-19","2025-05-01","2025-07-22","2025-08-12","2025-08-12","2025-08-12","2023-09-05","2024-05-30","2024-05-30","2023-04-11","2024-02-07","2024-02-07","2023-09-19","2023-09-19","2023-08-01","2023-08-01","2023-08-01","2023-11-17","2024-05-29","2024-06-11","2024-05-29","2024-05-29","2024-11-21","2023-10-02","2025-08-24","2025-05-01","2025-09-04","2025-05-01","2023-08-09","2024-07-30","2023-11-14","2023-09-05","2024-12-19","2024-12-19","2023-11-14","2023-08-01","2024-02-07","2023-08-01","2025-06-06","2022-11-08","2022-11-08","2022-11-08","2022-11-08"],"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":[["","","MOUNJARO","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","ALFUZOSIN HCL ER","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","METFORMIN ER GASTRIC","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","ATROPINE SULFATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","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":{"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":""}]}]}