{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William D Lackey","gend":0,"currentgend":"","add":"19 PINE LEDGE DR","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1939-10-10","age":"","mstatus":"","insh":"10000058359","cliId":"","pno":8309929392,"cno":"","email":"billlackey19@gmail.com","ename":"","eno":"","pphy":"OSULLIVAN, SEAN T","ppno":"","pcpadd":"76 High St Fl 1,","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"19 PINE LEDGE DR","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":"","pcpnpi":1285073205,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7WM5A01FF62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4821","I5020","I2510","I081","I77810","N1830","S80212A","C61","Z95810","I5023","I10","R9720","E871","R7303","I25118","I4891","I440","C44311","L578","L570","R6889","R079","I447","I340","R55","I429","I110","I080","I700","I509","I252","D509","I255","R42","I493","S80211A","W268XXA","Z7901","S51819D","S51819A","Z0100","H903","I77819","R931","D485","I088","Z136","S61210D","S61210A","R918","J181","J90","Z0101","R0789"],"date":["2023-07-11","2025-06-17","2025-06-17","2025-08-15","2024-06-03","2024-08-12","2025-09-05","2025-08-06","2025-07-14","2025-06-27","2024-06-17","2024-08-12","2023-05-01","2023-05-01","2023-07-21","2023-07-21","2023-07-21","2025-06-26","2025-06-26","2025-06-26","2023-12-11","2023-06-24","2023-06-17","2023-07-07","2024-01-24","2023-06-25","2023-06-25","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-23","2023-06-25","2024-01-24","2023-06-24","2024-11-11","2024-11-11","2024-11-11","2023-10-05","2023-10-04","2023-09-05","2023-11-03","2025-08-15","2025-08-15","2024-07-31","2023-05-16","2024-01-25","2024-01-26","2024-01-24","2024-01-24","2023-06-17","2023-06-17","2024-10-22","2023-06-17"],"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":[["","","SPIRONOLACTONE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","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":""}]}]}