{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jerome A Beatty","gend":0,"currentgend":"","add":"13 AMETHYST WAY","city":"FALMOUTH","state":"ME","zip":"04105","dob":"1953-02-20","age":"","mstatus":"","insh":"10000059508","cliId":"","pno":2074085558,"cno":"","email":"tommytoms@msn.com","ename":"","eno":"","pphy":"BUCHBERGER, GLENN K","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 700","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"13 AMETHYST WAY","madd2":"","madd3":"","mcity":"FALMOUTH","mstate":"ME","mzip":"04105","pcpfaxno":2075238597,"pcpnpi":1598054702,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3P08E94GU24","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M4602","M4607","R293","R1013","R0789","I10","I2510","L03811","H903","M4606","M4802","M542","J00","N401","R7303","Z0001","H6123","I517","I6523","L578","D229","L821","L814","L570","Z0000","Z0100","L989","Z85828","E669","Z1159","E782","Z13220","R079","Z125","Z6836","I25119","I2089","H6012","I493","I5189","I6529","J0190","I2584","D485","L0390","C44519","R748","I779","B001","Z1211","K219","N4289","M5412","M50221","M5450","G8929","R6889"],"date":["2023-08-07","2023-08-07","2024-11-01","2025-02-21","2025-02-13","2025-09-11","2025-09-03","2024-10-23","2025-11-19","2024-11-01","2024-11-01","2024-11-01","2025-04-21","2025-09-11","2025-09-11","2025-09-11","2024-06-26","2025-08-28","2025-08-28","2024-08-13","2024-08-13","2024-08-13","2023-08-09","2024-08-13","2023-08-30","2024-06-05","2023-06-09","2023-06-09","2023-06-09","2023-08-30","2025-02-24","2023-08-30","2025-02-04","2023-08-30","2023-08-30","2025-02-07","2025-02-13","2024-10-25","2025-02-03","2025-02-03","2024-10-25","2024-11-26","2025-02-04","2024-08-13","2024-10-21","2024-11-26","2025-02-13","2025-02-24","2024-08-13","2022-08-17","2022-09-09","2022-08-05","2021-12-22","2021-12-22","2021-12-22","2021-12-22","2021-01-19"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","GABAPENTIN","","","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":""}]}]}