{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald D Englehart","gend":0,"currentgend":"","add":"19 BOBBY ST","city":"LEWISTON","state":"ME","zip":"04240","dob":"1952-10-13","age":"","mstatus":"","insh":"10000055369","cliId":"","pno":2072410555,"cno":"","email":"dprincess486@mail.com","ename":"","eno":"","pphy":"LATKOVICH, KATARINA Z","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400 CENTRAL MAINE INTERNAL MEDICINE","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"19 BOBBY ST","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":2077955727,"pcpnpi":1902878499,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6DR9R81QJ58","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J310","B20","C3490","K5730","Z85118","G4733","Z08","Z9222","Z9221","C3430","R6889","B351","M79675","M79674","E1159","L89892","N289","J449","K5792","J439","K7460","R109","R3915","I959","J479","J9611","R059","K5900","R600","R55","R4789","R350","I10","D122","D125","K529","L03032","L89893","J441","N179","J4489","R0603","E139","Z0101","K5732","Z9981","R918","J101","K640","K766","R000","I452","K7469","Z452","R197","M549","L7211","R2230","M25511","R0602","R509","L603","L600","L989","M5450","R0902","N3281","J432","J9811","R079","U071","Z09","R0600","J189","Z79899","I2510","C7801","C7802","C779","E113291","E860"],"date":["2025-07-31","2025-08-14","2025-10-20","2025-08-06","2025-10-06","2025-11-03","2024-04-03","2024-04-03","2024-04-03","2023-01-09","2023-11-28","2025-11-17","2025-11-17","2025-11-17","2025-11-17","2025-11-17","2023-08-23","2025-11-03","2025-11-12","2025-06-19","2025-10-31","2025-10-31","2024-10-07","2025-05-03","2025-06-19","2025-06-19","2025-05-19","2025-09-11","2024-07-15","2025-05-03","2025-05-03","2024-10-07","2025-04-19","2025-07-09","2025-07-09","2025-08-14","2025-06-30","2025-06-10","2025-04-19","2025-05-19","2025-11-11","2025-04-19","2025-04-07","2024-12-03","2025-06-23","2023-10-23","2023-09-21","2024-02-28","2025-07-09","2025-06-23","2024-02-27","2024-02-27","2025-11-10","2024-08-20","2025-06-11","2023-07-17","2022-12-15","2022-12-05","2025-05-03","2025-05-03","2025-05-03","2023-09-11","2023-04-17","2022-12-15","2023-10-09","2025-03-06","2025-07-03","2024-03-29","2024-03-29","2024-02-27","2023-12-11","2024-08-13","2023-12-11","2024-11-21","2022-11-17","2022-09-12","2022-09-14","2022-09-14","2022-09-14","2022-09-07","2022-08-29"],"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":[["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","KLOR-CON M20","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","BEVESPI AEROSPHERE","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BIKTARVY","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TOBRAMYCIN","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","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":[]}},{"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":""}]}]}