{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William J Gaynor","gend":0,"currentgend":"","add":"10 THE LONG AND WINDING RD","city":"KENNEBUNKPORT","state":"ME","zip":"04046","dob":"1952-03-07","age":"","mstatus":"","insh":"10000054862","cliId":"","pno":2074683002,"cno":"","email":"bgaynor@legacysir.com","ename":"","eno":"","pphy":"LOFFREDO, BRETT M","ppno":2072838800,"pcpadd":"SMHC Family Medicine,13 Industrial Park Rd Ste 2","pcpcity":"Saco","pcpstate":"ME","pcpzip":"04072","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1473","madd2":"","madd3":"","mcity":"KENNEBUNKPORT","mstate":"ME","mzip":"04046","pcpfaxno":2072943561,"pcpnpi":1295809911,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2MT8Y82KQ25","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1165","L570","L578","L814","L821","Z85820","I2111","I7789","I25110","E7800","I2510","R310","I517","C44329","Z0000","Z872","Z85828","D492","R222","R6889","I700","I77810","L308","Z125","R002","R008","S61212A","D224","R61","R079","I252","I10","R918","Z1211","Z86010","K635","Z808","D124","K219","R739","Z0101","T1511XA","I4720","R931","I213","Z859","Z23","R0789","Z8249","M1712","M25562","G8929","H5203","H52223","H524"],"date":["2025-01-15","2025-05-13","2025-05-13","2025-05-13","2025-05-13","2024-12-23","2022-11-26","2025-05-08","2022-11-26","2025-09-25","2025-05-08","2023-08-15","2024-04-24","2025-06-03","2025-09-19","2023-10-04","2023-10-04","2025-05-13","2025-07-20","2023-03-22","2023-08-04","2024-04-24","2023-10-04","2023-08-23","2023-02-09","2023-02-09","2024-12-23","2023-01-09","2024-09-23","2024-09-25","2024-09-23","2024-12-23","2023-11-06","2024-03-11","2024-03-11","2024-03-11","2023-01-09","2024-03-11","2024-03-11","2024-10-11","2024-01-29","2022-11-08","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-11-15","2022-11-25","2022-11-25","2022-08-10","2022-07-01","2022-07-01","2022-04-27","2022-04-27","2022-04-27"],"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",""],["","","LISINOPRIL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","SHINGRIX","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"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":""}]}]}