{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Craig M Doremus","gend":0,"currentgend":"","add":"28 BLACK POINT RD","city":"NEW GLOUCESTER","state":"ME","zip":"04260","dob":"1953-03-27","age":"","mstatus":"","insh":"10000060255","cliId":"","pno":2079265122,"cno":"","email":"cdoremus@gmail.com","ename":"","eno":"","pphy":"HILARY, MANJU","ppno":2076573308,"pcpadd":"126 SHAKER RD,","pcpcity":"GRAY","pcpstate":"ME","pcpzip":"40399629","pcpcounty":"","pcpid":"","pcpname":"GRAY FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 BLACK POINT RD","madd2":"","madd3":"","mcity":"NEW GLOUCESTER","mstate":"ME","mzip":"04260","pcpfaxno":2076573309,"pcpnpi":1710066410,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2JC8JU4UM48","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","Z950","I480","F902","H401131","M5450","R4182","R509","G4733","J189","G2581","Z1389","J09X9","G9341","Z1152","R9431","R21","Z0000","Z45018","Z0100","D649","R059","J90","R6889","F909","E871","R140","K8689","Z86010","G479","N401","I441","R030","I3139","I4892","I319","J101","R195","Z800","M549","R12","G4730","R251","M47816","M5136","G8929","R918","R079","I499","Z959","I519","E785","Z872","M25561","L989","Z125","I314","R0602","K638219","K219","Z860100","D225","N489","I311","H2511","Z09","E222","H409","Z6827","M419","Z6828","R7989","R002","H401121","L570","D485","Z1211","D120","K5730","J0190","H16223","H16102","H35363","L2089","R3915","N400","R1013","H26492","Z1283","Z0189","N179","H25812","R351","N486","H25813","I409","I309","Z23","N433","Z13228"],"date":["2024-12-12","2025-10-28","2024-11-15","2025-08-25","2025-09-23","2024-02-28","2024-03-03","2024-03-03","2024-03-13","2024-04-17","2025-04-15","2023-08-23","2024-03-03","2024-03-03","2024-03-03","2024-03-03","2025-08-22","2025-03-14","2024-01-22","2022-12-08","2025-09-22","2025-10-28","2025-11-12","2023-12-14","2024-07-29","2025-10-24","2025-11-06","2023-11-13","2023-06-15","2023-01-14","2025-01-28","2024-11-15","2025-10-08","2025-11-12","2025-11-12","2025-11-12","2024-03-03","2023-11-13","2024-09-24","2025-07-29","2025-11-06","2024-01-08","2024-03-03","2024-01-22","2024-01-22","2024-01-22","2025-09-30","2025-10-15","2025-10-08","2025-10-08","2025-10-12","2025-09-22","2025-09-22","2023-05-12","2024-09-24","2025-03-07","2025-10-24","2025-10-08","2025-08-28","2025-08-28","2025-09-04","2024-10-03","2023-11-17","2025-10-08","2025-09-23","2025-10-08","2025-10-08","2023-03-08","2023-03-08","2023-03-13","2025-03-14","2023-09-05","2025-10-22","2024-07-23","2024-10-03","2024-10-03","2025-09-04","2025-09-04","2025-10-08","2025-01-23","2025-10-20","2025-10-20","2025-10-20","2025-09-02","2025-09-11","2025-10-08","2023-11-13","2025-09-23","2024-04-23","2025-10-14","2025-09-30","2024-07-23","2025-01-28","2025-01-28","2024-05-16","2025-10-15","2025-10-15","2022-10-27","2022-10-04","2022-10-20"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","TROSPIUM CHLORIDE","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHET ER","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","LUMIGAN","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","TRIAZOLAM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","TOLTERODINE TARTRATE ER","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","VYVANSE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","AREXVY","","","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":""}]}]}