{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul R Beote","gend":0,"currentgend":"","add":"30 RICHARDSON ST","city":"PORTLAND","state":"ME","zip":"04103","dob":"1947-08-04","age":"","mstatus":"","insh":"10000061177","cliId":"","pno":2077731085,"cno":"","email":"gbeote@aol.com","ename":"","eno":"","pphy":"HEARD CUSHING, KAREN S","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","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":"30 RICHARDSON ST","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2075238597,"pcpnpi":1720421217,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3HR1DH0EF96","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C44329","H353221","R55","Z95818","E1165","H5203","K7581","K7401","M25561","D649","E1129","E611","R197","R1030","R42","E1159","I10","E1169","G4733","M25461","I088","I288","L570","L578","Z85828","E668","R6889","E1136","E538","D225","L218","H353112","H40013","H2513","R21","Z23","K760","D509","D124","E785","E119","E1121","I480","K3189","Z860101","Z0001","I4891","I8500","Z0000"],"date":["2024-08-27","2025-11-12","2025-09-30","2025-05-12","2025-02-27","2025-07-30","2025-07-07","2025-03-20","2025-02-27","2025-04-17","2025-02-27","2025-07-07","2024-03-17","2024-03-17","2024-03-17","2025-07-07","2025-09-17","2025-01-31","2025-04-01","2025-02-27","2025-02-28","2025-02-28","2025-10-21","2024-08-27","2025-10-21","2024-04-10","2023-04-24","2023-05-10","2024-02-02","2025-10-21","2025-10-21","2024-11-21","2024-07-25","2023-01-18","2022-12-21","2025-09-24","2023-06-16","2025-07-01","2025-05-08","2023-02-13","2023-01-09","2025-09-17","2025-09-17","2025-07-01","2025-07-01","2025-02-07","2025-07-10","2025-04-17","2022-11-15"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ENGERIX-B ADULT","","","Select","Select",""],["","","HAVRIX","","","Select","Select",""],["","","JARDIANCE","","","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":{"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":""}]}]}