{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brian C Folsom","gend":0,"currentgend":"","add":"639 CALAIS RD","city":"HOULTON","state":"ME","zip":"04730","dob":"1948-02-06","age":"","mstatus":"","insh":"10000059580","cliId":"","pno":2075835728,"cno":"","email":"","ename":"","eno":"","pphy":"NIELSEN, LISA","ppno":2075282285,"pcpadd":"PO BOX 500,","pcpcity":"PATTEN","pcpstate":"ME","pcpzip":"47650500","pcpcounty":"","pcpid":"","pcpname":"KATAHDIN VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"639 CALAIS RD","madd2":"","madd3":"","mcity":"HODGDON","mstate":"ME","mzip":"04730","pcpfaxno":2075282880,"pcpnpi":1598706970,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1FG7E68ET20","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R918","S56901A","R4189","Z6835","J029","I2510","I77810","U099","I7120","R221","E559","H25813","I6523","D171","R911","R0981","I10","R7302","M7910","H25812","H25811","K760","Z0000","E785","H9193","L918","H11151","H11152","G609","R42","R6889","R0982","R059","Z8616"],"date":["2023-06-22","2023-10-30","2025-09-02","2023-12-31","2023-12-31","2023-06-22","2023-06-22","2022-10-31","2022-10-31","2022-12-21","2023-01-30","2025-08-21","2025-07-31","2023-02-07","2023-06-22","2025-05-12","2025-01-13","2023-10-16","2023-10-16","2025-08-14","2025-08-14","2022-12-21","2025-03-14","2023-01-30","2023-09-27","2023-08-31","2025-07-25","2025-07-25","2023-07-17","2025-06-25","2022-08-22","2022-08-22","2022-08-22","2022-08-22"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","AMOXICILLIN","","","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":""}]}]}