{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Arthur E Ray","gend":0,"currentgend":"","add":"1159 MILTON MILLS RD","city":"ACTON","state":"ME","zip":"04001","dob":"1944-05-13","age":"","mstatus":"","insh":"10000057864","cliId":"","pno":2076362792,"cno":"","email":"nitamyler21@gmail.com","ename":"","eno":"","pphy":"LOBEL, MOLLY W","ppno":"","pcpadd":"1 Medical Center Dr,","pcpcity":"Biddeford","pcpstate":"ME","pcpzip":"40059422","pcpcounty":"","pcpid":"","pcpname":"NASSON OFFSITE CLINICAL CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1159 MILTON MILLS RD","madd2":"","madd3":"","mcity":"ACTON","mstate":"ME","mzip":"04001","pcpfaxno":"","pcpnpi":1396414512,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5UG4H38CE67","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z96652","M25562","M25662","R262","M25561","M25661","Z0101","H40012","H401113","H2512","R7303","I10","I214","N5082","H119","H5711","H02051","N1831","E118","I252","R079","Z471","B950","R9431","I2510","I491","R0600","R9439","H11002","J329","M1712","Z955","G8918","H1045","H4720","E782","R6889","H401134","H401114","H11052","M1711","R21","Z23","R531","H5202","Z01818","M19072","Z125","M13861","M79672","H401124","R001","Z96651","H179","H1813","L989","R0789","Z7982","M2342","M170","Z7721"],"date":["2023-02-15","2023-02-15","2023-02-15","2023-06-29","2023-06-29","2023-06-29","2025-06-09","2025-06-09","2025-06-09","2023-08-22","2023-09-01","2025-07-10","2024-05-07","2025-01-15","2023-08-30","2023-08-30","2023-08-30","2025-11-18","2025-08-26","2025-07-10","2024-07-02","2023-05-05","2025-10-14","2024-05-09","2024-05-07","2024-05-09","2024-05-06","2024-05-06","2023-06-20","2025-08-26","2022-12-17","2025-07-10","2023-04-21","2023-11-08","2024-12-09","2025-01-15","2023-11-17","2023-01-12","2023-03-30","2023-06-20","2023-04-21","2023-09-14","2025-07-17","2022-12-07","2024-06-07","2023-04-07","2025-04-24","2022-11-28","2023-04-21","2025-04-24","2023-03-30","2024-05-09","2023-05-05","2023-08-07","2023-06-20","2023-09-21","2024-04-23","2022-12-17","2022-10-14","2022-08-10","2022-09-09"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BRILINTA","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TICAGRELOR","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","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":""}]}]}