{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert J Kelly","gend":0,"currentgend":"","add":"17 COLONIAL WAY","city":"AUBURN","state":"ME","zip":"04210","dob":"1948-08-13","age":"","mstatus":"","insh":"10000056664","cliId":"","pno":5083410433,"cno":"","email":"weezen@comcast.net","ename":"","eno":"","pphy":"CHAFFIN, SCOTT J","ppno":"","pcpadd":"1400 POTTERY AVE,","pcpcity":"PORT ORCHARD","pcpstate":"WA","pcpzip":"98366371","pcpcounty":"","pcpid":"","pcpname":"MINOT AVENUE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"17 COLONIAL WAY","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":3608955034,"pcpnpi":1205891637,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7ND5CV6QN71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","Z794","Z86010","D120","D122","K635","I2510","I10","I350","G629","R809","E785","Z09","Z7984","L570","R6889","C44329","Z1211","D123","K5730","R195","B351","E1142","M79675","M79674","L853","I739","K621","D225","L814","L821","L568","C4442","H5213","E11319","I77810","I352","I3481","D492","K760","E1165","H52223","Z87891","Z122","E6601","R748","R7401","Z955","Z7982","Z0000","Z136","E782","I70219","L7621","Y838","Y92818","E1159","R911","S1096XA","Z7689","I471","H01015","H02883","H02886","E1169","G4700","Z1212"],"date":["2025-09-24","2025-08-05","2023-12-19","2024-06-25","2024-06-25","2025-07-15","2025-05-08","2025-09-15","2024-04-26","2023-04-27","2024-02-02","2025-08-05","2025-05-08","2023-05-01","2025-07-14","2023-12-29","2025-07-14","2025-07-15","2024-06-25","2025-07-15","2023-10-31","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2023-04-20","2023-07-18","2025-07-15","2025-06-02","2025-06-02","2025-06-02","2025-06-02","2025-11-04","2024-09-06","2024-09-06","2024-08-28","2024-08-28","2024-08-28","2025-10-13","2024-09-04","2023-02-07","2023-09-01","2025-01-12","2023-11-01","2024-04-26","2023-10-18","2023-10-18","2023-08-15","2023-08-15","2023-08-15","2023-10-18","2023-10-02","2023-07-18","2025-11-09","2025-11-09","2025-11-09","2023-09-19","2023-11-01","2022-11-22","2022-11-15","2022-11-15","2022-08-25","2022-08-25","2022-08-25","2022-08-17","2022-08-17","2022-09-02"],"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":[["","","CLOPIDOGREL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NOVOLOG MIX 70-30 FLEXPEN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","AMMONIUM LACTATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","INSULIN ASPART PROT MIX 70-30","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","BAQSIMI","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","ERYTHROMYCIN","","","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":{"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":""}]}]}