{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christophe W Wiley","gend":0,"currentgend":"","add":"15 MIDDLE ST 506","city":"PORTLAND","state":"ME","zip":"04101","dob":"1952-06-05","age":"","mstatus":"","insh":"10000055116","cliId":"","pno":6033985777,"cno":"","email":"","ename":"","eno":"","pphy":"SUBAK KRAH, SARAH","ppno":2077745816,"pcpadd":"100 FODEN ROAD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 MIDDLE ST 506","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04101","pcpfaxno":2078741483,"pcpnpi":1780643437,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AU7TU7MK42","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G959","G2581","H40053","Z0101","M25511","M75111","M5412","Z23","H93293","M75121","R413","R202","R7989","R7301","E7800","I10","H9192","H9312","Z125","Z98890","C4441","D224","Z0000","J4531","D492","C44319","M4802","M4722","M4312","Z85828","M19011","L570","R748","L821","L578","M75101","M7541","R200","G8918","Z0001","Z1212","Z1211","R6889"],"date":["2025-07-17","2025-07-17","2024-02-22","2024-02-22","2025-07-18","2025-07-18","2025-01-07","2025-09-18","2024-05-20","2025-02-18","2025-06-17","2025-06-17","2025-01-24","2025-01-24","2025-01-24","2025-01-24","2024-05-16","2024-05-16","2025-01-24","2025-05-28","2024-06-24","2024-05-23","2024-01-11","2025-04-09","2024-05-23","2023-08-24","2024-12-23","2024-12-23","2024-12-23","2024-05-23","2025-02-18","2023-12-18","2024-03-25","2024-05-23","2024-05-23","2025-02-26","2025-02-18","2024-09-11","2025-02-18","2025-01-17","2024-04-16","2024-04-16","2021-12-08"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","BREYNA","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DAYVIGO","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LUMIGAN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","METFORMIN 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":[]}},{"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":""}]}]}