{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Philip R Farrell","gend":0,"currentgend":"","add":"411 DURHAM RD","city":"New Gloucester","state":"ME","zip":"04260","dob":"1949-04-05","age":"","mstatus":"","insh":"10000059169","cliId":"","pno":2072104850,"cno":"","email":"FPARRELL3618@GMAIL.COM","ename":"","eno":"","pphy":"PATCH, JEFFREY S","ppno":2078469013,"pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"411 DURHAM RD","madd2":"","madd3":"","mcity":"New Gloucester","mstate":"ME","mzip":"04260","pcpfaxno":2078741483,"pcpnpi":1720067317,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7CF5HE1YC64","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":["M25512","M25612","M6281","R531","K648","E1159","M75112","M75102","M75101","M75122","E1136","M7522","M19012","E785","I2510","Z0000","E039","E669","Z01812","E119","Z0101","H5212","M778","Z23","J069","H81399","H5712","M25511","R6889","R42","H2513","R519","M2550","Z4789","G8918","H05242","M19011","M62838","N5089","N50819","N451","N50811","N503","S2231XA","K5730","Z800","K641","Z20822","U071"],"date":["2025-02-27","2025-03-04","2025-02-27","2024-11-21","2024-01-22","2025-08-14","2024-09-17","2024-02-28","2024-02-28","2024-07-09","2025-08-14","2024-03-05","2024-03-01","2025-04-02","2025-04-02","2025-04-09","2024-09-11","2024-04-25","2024-04-18","2024-04-18","2025-01-31","2025-01-31","2024-01-31","2025-11-13","2023-02-01","2024-12-21","2025-09-17","2024-01-31","2023-11-27","2025-07-14","2023-11-20","2025-07-14","2024-09-18","2024-05-06","2024-04-25","2025-07-14","2024-01-31","2024-06-05","2022-11-03","2022-11-22","2022-11-22","2022-11-04","2022-11-03","2022-05-30","2021-11-17","2021-11-17","2021-11-17","2022-01-19","2022-01-19"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","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":""}]}]}