{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Harold R Wheeler","gend":0,"currentgend":"","add":"78 THOMAS BAY LN","city":"BAR HARBOR","state":"ME","zip":"04609","dob":"1949-03-27","age":"","mstatus":"","insh":"10000054049","cliId":"","pno":2076100139,"cno":2076100139,"email":"HOOKWHEELER@GMAIL.COM","ename":"","eno":"","pphy":"WITHAM, PETER H","ppno":2072445630,"pcpadd":"50 UNION STREET,","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"COOPER GILMORE HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"78 THOMAS BAY LN","madd2":"","madd3":"","mcity":"BAR HARBOR","mstate":"ME","mzip":"04609","pcpfaxno":2076647721,"pcpnpi":1417043639,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5MK3C04GF71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D329","H353130","H43823","H34823","H43813","R6889","Z0000","D320","Z5189","H539","G9389","E785","I639","H9193","Z23","H40013","H43393","H25813","H353132","K2100","K319","D123","Z1211","Z09","M25561","H538","H353131","Z86010","H6123","H35373"],"date":["2025-08-14","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2023-11-06","2025-01-10","2024-04-05","2022-12-02","2024-01-03","2024-01-03","2023-12-14","2025-08-14","2023-08-22","2024-10-29","2025-07-15","2025-07-15","2025-07-15","2023-08-21","2024-03-25","2024-03-25","2024-03-25","2024-03-25","2024-03-25","2025-04-23","2024-05-23","2023-11-29","2024-01-31","2024-08-26","2022-09-21"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}