{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leo M Ayotte","gend":0,"currentgend":"","add":"16 NEW RD","city":"Lyman","state":"ME","zip":"04002","dob":"1950-01-12","age":"","mstatus":"","insh":"10000059386","cliId":"","pno":2075025285,"cno":"","email":"declined@081221.com","ename":"","eno":"","pphy":"LETELLIER, TERESA","ppno":2072831441,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"16 NEW RD","madd2":"","madd3":"","mcity":"Lyman","mstate":"ME","mzip":"04002","pcpfaxno":2075231136,"pcpnpi":1629431622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6YX2QV4WQ89","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":["I5022","E785","I509","R0789","I4720","R4182","K219","Z95810","M109","I130","Z23","I214","Z4682","I082","I517","I5020","Z952","I77810","I255","I420","I2510","I340","R0602","R6889","H353111","L03113","Z951","I2582","I10","I50810","I2720","I25118","R928","N6489","N62"],"date":["2025-11-19","2024-09-27","2024-06-30","2024-06-30","2024-11-15","2023-05-24","2023-05-24","2025-09-02","2023-11-01","2024-06-30","2024-10-03","2023-05-20","2023-05-19","2025-11-04","2023-05-22","2023-05-22","2023-05-22","2023-05-22","2024-11-15","2024-11-15","2023-09-19","2023-09-19","2024-07-01","2023-09-05","2023-09-05","2024-08-21","2023-05-24","2023-05-23","2024-09-27","2022-05-16","2022-05-16","2022-04-29","2022-03-31","2022-03-31","2022-03-31"],"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":[["","","JARDIANCE","","","Select","Select",""],["","","SOTALOL","","","Select","Select",""],["","","EPLERENONE","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","TORSEMIDE","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}