{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leonard W Maxwell","gend":0,"currentgend":"","add":"20 WALNUT DR","city":"WINDHAM","state":"ME","zip":"04062","dob":"1941-04-05","age":"","mstatus":"","insh":"10000059149","cliId":"","pno":2078938162,"cno":"","email":"declined@110320.com","ename":"","eno":"","pphy":"NIXON, EMILY J","ppno":"","pcpadd":"MaineHealth Primary Care Internal Medicine and Ped,582 Roosevelt Trl","pcpcity":"Windham","pcpstate":"ME","pcpzip":"04062","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE AND PED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 WALNUT DR","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":"","pcpnpi":1083236459,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2M63K67CQ07","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R5383","G3184","J441","S335XXA","L570","C61","R339","L814","L821","D1801","L309","D492","G301","F02A3","F03A3","G479","F419","R419","I10","N390","Z8546","D122","Z86010","D123","D124","H52203","Z0000","H2512","H35363","D3131","H01003","J449","D649","H40013","E875","E559","R739","F10120","S80212A","D72829","Z87891","S0990XA","W19XXXA","D225","I129","N1831","Z08","Z923","R4181","Z23","L910","D485","N3000","N1832","E7800","M109","H9193","B351","I7389","G608","E538","R0609","Z136","E785","Z789","R0602","L03012"],"date":["2023-04-11","2025-06-05","2025-11-10","2024-12-18","2023-02-09","2024-05-21","2023-11-02","2025-03-06","2025-03-06","2024-02-08","2025-03-06","2023-02-09","2025-06-05","2025-06-05","2025-09-03","2025-09-03","2025-09-03","2025-09-03","2025-08-26","2024-03-25","2024-06-13","2023-10-26","2023-10-26","2023-10-26","2023-10-26","2024-11-13","2025-07-18","2025-11-17","2025-11-17","2025-11-17","2023-04-13","2025-01-17","2024-04-08","2025-11-17","2025-08-04","2023-10-17","2024-03-19","2023-08-27","2023-08-27","2023-08-27","2023-08-27","2023-08-27","2023-08-27","2025-03-06","2023-01-12","2023-01-12","2024-06-13","2024-06-13","2024-10-09","2023-07-18","2024-01-02","2024-01-02","2024-03-25","2025-08-26","2023-10-17","2023-10-17","2025-08-26","2024-10-22","2024-10-22","2024-10-22","2022-10-26","2022-11-03","2022-11-01","2022-10-25","2022-10-25","2022-11-03","2022-08-06"],"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":[["","","SERTRALINE HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","LABETALOL HCL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","TIOTROPIUM BROMIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","SPIRIVA HANDIHALER","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}