{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Larry G Poulin","gend":0,"currentgend":"","add":"115 POULIN DR","city":"READFIELD","state":"ME","zip":"04355","dob":"1952-12-05","age":"","mstatus":"","insh":"10000058435","cliId":"","pno":2074587124,"cno":2072152933,"email":"Larrypoulin115@gmail.com","ename":"","eno":"","pphy":"MURPHY, ROCHELLE S","ppno":2076243800,"pcpadd":"Winthrop Family Medicine,149 Main St","pcpcity":"Winthrop","pcpstate":"ME","pcpzip":"04364","pcpcounty":"","pcpid":"","pcpname":"WINTHROP FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 189","madd2":"","madd3":"","mcity":"READFIELD","mstate":"ME","mzip":"04355","pcpfaxno":2076243845,"pcpnpi":1245585108,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3YG5Q70AX52","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K5289","D469","D46B","I25118","Z951","G4733","M79672","D709","Z01810","I2510","R6889","H538","M25532","R5383","D649","D531","F1090","M19032","M7989","M79671","D210","R0602","R079","G4730","Z48812","I6523","R140","Z98890","J9811","Z0000","B351","D539","I2584","K529","I517","J90","D72819","R059","R700","R109","D4620","W19XXXA","X500XXA","J069","R778","D6489","Z4682","E785","I340","I10","H35013","I4891","I9789","R9431","D122","Z1211","K5730","Z86010"],"date":["2024-11-11","2025-11-04","2025-10-21","2025-04-11","2025-08-01","2025-10-16","2023-06-06","2024-06-18","2025-04-10","2025-06-05","2023-07-26","2025-05-23","2023-02-08","2025-09-23","2025-09-24","2025-09-02","2025-09-02","2023-02-08","2023-02-08","2023-06-06","2023-06-06","2025-04-10","2025-04-10","2025-04-11","2025-05-01","2025-04-10","2025-04-15","2025-04-15","2025-05-01","2025-07-07","2023-06-21","2025-09-10","2025-04-10","2024-11-07","2025-04-10","2025-05-01","2025-09-10","2025-03-25","2025-03-25","2024-11-07","2025-11-04","2023-02-08","2023-02-08","2023-02-08","2025-07-28","2025-09-10","2025-04-16","2023-06-14","2025-04-11","2025-04-11","2023-05-05","2025-05-14","2025-05-14","2025-03-24","2022-09-29","2022-09-29","2022-09-29","2022-09-29"],"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":[["","","COLCHICINE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}