{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Terry N Parsons","gend":0,"currentgend":"","add":"508 HARRISON RD","city":"NAPLES","state":"ME","zip":"04055","dob":"1949-03-14","age":"","mstatus":"","insh":"10000054062","cliId":"","pno":2074611705,"cno":2074131096,"email":"declined@022425.com","ename":"","eno":"","pphy":"MATUSOVICH, CHARLES S","ppno":2078566010,"pcpadd":"North Bridgton Family Practice,14 Wyonegonic Rd","pcpcity":"North Bridgton","pcpstate":"ME","pcpzip":"04057","pcpcounty":"","pcpid":"","pcpname":"NORTH BRIDGTON FAMILY PRACTICE AND WALK IN CLINIC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"508 HARRISON RD","madd2":"","madd3":"","mcity":"NAPLES","mstate":"ME","mzip":"04055","pcpfaxno":2078579324,"pcpnpi":1134143514,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2E92YY3KK06","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1611","M87051","S72009A","Z01818","E119","R0600","K222","T84124A","S72141K","J449","R52","S72141D","R059","S72041A","S72001A","S72301K","Z471","Z96641","R6884","M25451","I499","S72141A","R300","Z96649","I2510","M1711","S72143A","M25561","Z09","R9431","Z1212","Z1211","I10","E785","R1310","M19071","S0502XA","M109","M79674","J029","Z0000","Z4802","K2090","M160","S72051D","I213","I2111","I2121","I2119","I249","Z955","I255","R079","R0602","I2109","I2582"],"date":["2025-04-22","2025-04-22","2025-11-10","2025-04-21","2025-04-22","2024-02-09","2024-02-15","2025-04-22","2025-04-22","2025-04-22","2025-07-28","2025-05-28","2024-11-01","2024-11-01","2025-04-18","2025-04-21","2025-04-28","2025-04-22","2024-12-03","2025-03-11","2025-04-04","2025-02-14","2025-02-04","2025-07-28","2025-04-02","2025-09-23","2025-04-14","2025-06-06","2025-05-14","2024-03-21","2024-01-02","2024-01-02","2024-03-21","2024-03-21","2024-02-15","2025-11-10","2023-10-01","2025-11-10","2025-11-10","2024-05-20","2023-12-12","2024-11-21","2023-03-07","2025-04-21","2024-12-04","2022-09-29","2022-09-13","2022-09-15","2022-09-15","2022-09-14","2022-09-16","2022-09-16","2022-09-13","2022-09-13","2022-09-13","2022-09-13"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","INSULIN SYRINGE U-500","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","INDOMETHACIN","","","Select","Select",""],["","","NOVOLIN 70-30 FLEXPEN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","IBU","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"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":""}]}]}