{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karl C Austin","gend":0,"currentgend":"","add":"65 MAIN ST","city":"BUCKSPORT","state":"ME","zip":"04416","dob":"1939-07-06","age":"","mstatus":"","insh":"10000057667","cliId":"","pno":2074696199,"cno":"","email":"jk_aust@twc.com","ename":"","eno":"","pphy":"PANDEY, SANJAY P","ppno":2079073300,"pcpadd":"St Joseph Internal Medicine,900 Broadway","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 882","madd2":"","madd3":"","mcity":"BUCKSPORT","mstate":"ME","mzip":"04416","pcpfaxno":2079071923,"pcpnpi":1407127475,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2AG3F74XX11","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","H04123","I10","J069","J189","I129","R1312","A4151","R1310","N3000","Z0000","N3281","N3941","R32","Z8546","Z9079","Z923","Z139","N401","N132","K5900","N200","Z466","K219","K224","N202","E1122","N1830","R7989","R109","R300","S0101XA","N35919","N136","Z87891","N3040","N1330","R1313","Z23","J310","S0990XA","W11XXXA","D126","E118","C61","K222","B029","E789","N1831","I444","E7800","Z4802","E785","R7309","M159","S199XXA","N210","K5730","R39198","S299XXA","J392","N400","M5450","R1012","R1032","N289","R319","D696","R000","N35912","Z882","Z888"],"date":["2025-06-11","2024-12-03","2025-06-11","2025-04-09","2025-04-14","2025-05-06","2025-02-20","2025-06-04","2025-01-28","2025-07-03","2024-10-30","2024-04-30","2024-02-13","2024-06-25","2024-06-25","2024-06-25","2025-01-15","2024-01-16","2025-01-08","2025-06-20","2023-08-12","2025-07-05","2025-07-01","2025-06-11","2023-12-21","2025-06-10","2025-03-07","2025-03-07","2025-03-08","2023-08-11","2024-04-23","2025-07-03","2023-09-14","2025-03-08","2025-03-08","2025-03-08","2025-06-04","2024-12-17","2025-07-03","2025-01-28","2025-07-03","2025-07-03","2023-10-25","2023-08-15","2024-10-30","2025-02-20","2023-01-10","2025-03-09","2025-03-09","2025-07-09","2023-01-10","2025-07-11","2024-10-01","2025-03-06","2024-10-01","2025-07-03","2025-03-07","2025-03-07","2023-03-27","2025-07-03","2024-12-17","2023-11-14","2023-08-11","2023-08-11","2023-08-11","2023-08-15","2023-12-12","2023-11-02","2025-07-09","2023-08-30","2023-08-30","2023-08-30"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","TOLTERODINE TARTRATE ER","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","ISOSORBIDE DINITRATE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","LEVOFLOXACIN","","","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":""}]}]}