{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter T Horsman","gend":0,"currentgend":"","add":"224 HIGHLAND AVE","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1953-02-01","age":"","mstatus":"","insh":"10000059731","cliId":"","pno":2077993818,"cno":"","email":"PETERTHORSMAN@GMAIL.COM","ename":"","eno":"","pphy":"KABAEVA, ZHYLDYZ T","ppno":2077672174,"pcpadd":"155 SPURWINK AVE,","pcpcity":"CAPE ELIZABETH","pcpstate":"ME","pcpzip":"41079604","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"224 HIGHLAND AVE","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2077671348,"pcpnpi":1730507336,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3DG0DE9KP25","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N1831","C7989","C649","K5730","C642","C786","R1909","K7689","Z01818","I10","M160","D84821","E1122","I358","M1612","E7800","F17200","J8410","R918","Z23","Z471","Z96642","K769","J984","Z5112","Z006","S61212A","R490","M25552","Z0000","Z905","R809","Z1211","M19012","R197","L298","Z79899","I77810","I700","R7303","Z720","N400","I080","Z5181","C762","R590","D649","R413","R739"],"date":["2024-07-30","2023-05-15","2025-10-21","2025-07-21","2025-10-21","2023-11-21","2023-05-15","2024-08-15","2025-09-17","2025-06-24","2023-03-15","2024-03-28","2023-03-15","2025-09-17","2023-08-10","2023-03-15","2023-03-15","2024-02-19","2024-02-19","2023-10-14","2023-03-29","2023-03-29","2023-12-11","2023-11-08","2024-08-23","2024-08-23","2024-06-25","2023-02-22","2022-12-23","2024-11-22","2025-09-29","2025-09-29","2024-11-29","2023-06-27","2023-09-19","2023-09-19","2023-05-15","2025-09-17","2022-11-18","2022-10-27","2022-09-27","2022-09-07","2022-09-09","2022-09-09","2022-07-06","2022-05-05","2022-04-29","2022-04-29","2021-12-15"],"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":[["","","CARVEDILOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","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":""}]}]}