{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas H Crosby","gend":0,"currentgend":"","add":"150 BROOK RD","city":"FALMOUTH","state":"ME","zip":"04105","dob":"1952-12-31","age":"","mstatus":"","insh":"10000058309","cliId":"","pno":"","cno":2074150796,"email":"tomhcrosby@gmail.com","ename":"","eno":"","pphy":"RICHARDS, SAMANTHA","ppno":2077984050,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"150 BROOK RD","madd2":"","madd3":"","mcity":"FALMOUTH","mstate":"ME","mzip":"04105","pcpfaxno":2077984018,"pcpnpi":1689960114,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1J79TU8MJ23","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S299XXA","M5459","G4733","M5137","M47816","M4316","R0609","R351","N400","R339","Z13228","S61211A","W260XXA","Z125","Z136","J069","M4726","M48061","M533","Z98890","M5432","L570","M5450","Z13220","Z23","L820","M4807","M5416","M48062","R6889","M5442","G8929","Z0100","L308","L821","D1801","D2371","M9903","M9904","M9905","M9906","M7918","N401","M25511","F5101","M25571","E785","B079"],"date":["2024-11-12","2023-09-06","2025-11-11","2023-09-06","2023-09-06","2023-11-30","2024-06-26","2024-07-01","2025-01-03","2025-01-03","2025-09-15","2023-01-20","2023-01-20","2024-09-09","2024-09-09","2023-03-07","2023-10-03","2023-10-03","2023-10-04","2023-10-04","2023-10-04","2024-09-16","2024-11-12","2025-09-15","2025-09-22","2025-04-08","2024-01-29","2024-01-29","2025-05-06","2023-01-17","2023-11-30","2023-11-30","2024-02-27","2023-04-25","2023-04-25","2023-04-25","2023-04-25","2023-06-08","2023-06-08","2023-06-08","2023-06-08","2023-06-08","2023-06-08","2023-06-08","2023-03-28","2022-09-22","2022-08-24","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":[["","","TAMSULOSIN HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","HAVRIX","","","Select","Select",""],["","","VAQTA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":""}]}]}