{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas C Ladd","gend":0,"currentgend":"","add":"27 BONIN RD","city":"MONMOUTH","state":"ME","zip":"04259","dob":"1958-12-14","age":"","mstatus":"","insh":"10000056780","cliId":"","pno":2074585001,"cno":"","email":"","ename":"","eno":"","pphy":"DUQUETTE, ADAM","ppno":2077847388,"pcpadd":"190 STETSON RD,","pcpcity":"AUBURN","pcpstate":"ME","pcpzip":"42107813","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"27 BONIN RD","madd2":"","madd3":"","mcity":"MONMOUTH","mstate":"ME","mzip":"04259","pcpfaxno":2077952043,"pcpnpi":1679884522,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2R72V11QM95","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47812","G959","G912","M5412","H401132","E113293","M9900","M9901","M9902","M9903","M542","M4726","M5451","M9904","E1122","Z9181","N184","R42","Z0000","E119","E669","E785","E1139","M5459","M5450","N189","E1165","I10","G9389","R9089","G919","M50021","M4802","M47816","G43E09","M539","R2689","I129","M1712","M5021","M4312","N2581","R809","E875","E1121","R2681","M5481","M48061","R1310","N179","E1142","M5386","M5136","E1169","T17308A","M5416","M5117","E113291","H35372","N1832","N1830","E211","Z23"],"date":["2024-07-05","2023-12-01","2025-01-10","2023-03-17","2025-07-01","2023-08-08","2024-12-12","2024-12-12","2024-12-12","2024-12-12","2024-09-16","2024-05-17","2024-08-26","2023-10-27","2025-06-27","2025-03-07","2025-06-27","2024-11-12","2025-07-31","2025-07-31","2025-07-31","2025-07-31","2025-10-18","2025-09-08","2025-10-31","2025-01-20","2024-09-24","2025-05-28","2023-02-22","2023-02-22","2023-02-22","2023-02-22","2023-02-22","2025-09-08","2025-01-10","2025-01-10","2024-11-30","2024-09-09","2024-09-09","2024-06-25","2024-06-25","2025-06-27","2024-09-30","2024-03-12","2025-09-17","2024-11-30","2024-01-31","2024-02-29","2023-07-12","2023-11-06","2024-01-18","2025-09-08","2024-01-05","2023-04-25","2023-06-20","2023-06-20","2024-02-29","2025-07-01","2025-07-01","2022-11-07","2022-11-16","2022-11-16","2022-10-10"],"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":[["","","CLONIDINE HCL","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","NURTEC ODT","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","GLIMEPIRIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","CALCITRIOL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","VELTASSA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FARXIGA","","","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":""}]}]}