{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas D Longley","gend":0,"currentgend":"","add":"99 A TURNER CENTER RD UNIT A","city":"TURNER","state":"ME","zip":"04282","dob":"1952-12-10","age":"","mstatus":"","insh":"10000056799","cliId":"","pno":2077544191,"cno":"","email":"tlongley@roadrunner.com","ename":"","eno":"","pphy":"BEGGS, ALEX W","ppno":2077955700,"pcpadd":"12 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407676","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"99 TURNER CENTER RD UNIT A","madd2":"","madd3":"","mcity":"TURNER","mstate":"ME","mzip":"04282","pcpfaxno":2077955727,"pcpnpi":1750862769,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9VP7JQ8XH46","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1711","R2242","Z08","M7989","G4733","G2581","C61","Z8546","Z923","Z9221","M7071","M25569","M4805","M5124","I2510","N1830","E785","M5416","M25561","N1831","Q600","Z905","D3000","M48061","K625","D125","M4804","M5450","L814","D225","L821","H25813","M79669","E7800","M5116","M4727","R6889","M4726","Z0000","M23361","M23321","M25461","M4714","I10","L02212","H35372","H40013","M1811","M79646","Z9223","N400","M79644","M654","R52","M19032","I129","Z01810","Z09","R001","M25532","Z01812","L0291","S83241A","F3342","I1310","I25119","L570","U071"],"date":["2025-10-28","2025-10-28","2025-07-08","2025-10-28","2025-11-14","2023-04-17","2024-05-28","2025-07-08","2025-07-08","2025-07-08","2025-10-28","2025-10-28","2025-04-07","2025-02-13","2025-03-27","2025-04-07","2025-03-27","2024-11-07","2025-07-01","2025-09-15","2023-09-06","2023-09-06","2023-09-06","2025-01-31","2022-12-22","2022-12-22","2025-02-12","2025-02-12","2024-10-29","2024-10-29","2024-10-29","2025-06-16","2024-11-26","2024-11-14","2025-01-31","2025-01-31","2023-11-09","2025-01-28","2024-11-14","2022-12-10","2022-12-10","2022-12-10","2025-04-07","2025-03-27","2023-05-16","2025-06-16","2025-06-16","2025-03-26","2024-02-20","2023-05-23","2023-11-08","2024-01-18","2024-01-18","2025-03-26","2025-03-26","2025-04-07","2025-03-29","2023-04-17","2023-04-17","2023-04-17","2025-04-02","2023-05-16","2022-11-10","2022-10-27","2022-10-27","2022-10-27","2022-10-05","2022-09-15"],"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":[["","","PRAMIPEXOLE DIHYDROCHLORIDE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","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":""}]}]}