{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David R Shaw","gend":0,"currentgend":"","add":"110 BEACH ST","city":"SACO","state":"ME","zip":"04072","dob":"1953-03-09","age":"","mstatus":"","insh":"10000060177","cliId":"","pno":2072848400,"cno":"","email":"malunka1953@gmail.com","ename":"","eno":"","pphy":"LEE, WOODROW D","ppno":2072863504,"pcpadd":"57 BARRA RD,SUITE #1","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"40059446","pcpcounty":"","pcpid":"","pcpname":"SEACOAST MEDICAL CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1233","madd2":"","madd3":"","mcity":"SACO","mstate":"ME","mzip":"04072","pcpfaxno":2072863767,"pcpnpi":1902908411,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4P41JN0EN13","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D122","Z86010","D123","K648","Z0101","G4733","C44519","L570","D492","Z23","H903","H6123","E1165","I10","E786","E119","E6609","Z136","Z1331","Z1389","Z0000","K635","L821","Z6839","R6889","C44219","L720","C44712","C44222","Z6838","N401","D044","Z85828","L578","L820"],"date":["2024-01-09","2024-01-09","2024-01-09","2024-01-09","2025-01-06","2025-06-24","2023-11-08","2025-11-05","2025-11-05","2024-11-01","2024-05-07","2024-05-07","2025-02-19","2025-02-24","2023-02-09","2025-08-13","2025-02-24","2024-11-21","2024-11-21","2024-11-21","2024-11-21","2023-02-09","2023-04-19","2023-02-09","2023-02-06","2023-04-19","2025-02-05","2025-11-05","2025-11-05","2024-11-21","2022-11-07","2022-11-09","2022-11-09","2022-11-09","2022-11-09"],"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",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","METFORMIN HCL","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}