{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raymond W Hall","gend":0,"currentgend":"","add":"156 N SEARSPORT RD","city":"SWANVILLE","state":"ME","zip":"04915","dob":"1953-08-07","age":"","mstatus":"","insh":"10000061651","cliId":"","pno":2073230539,"cno":"","email":"","ename":"","eno":"","pphy":"MOLISON, MATTHEW S","ppno":2079306708,"pcpadd":"118 NORTHPORT AVE,","pcpcity":"BELFAST","pcpstate":"ME","pcpzip":"49156009","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE AND WALK IN CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"156 N SEARSPORT RD","madd2":"","madd3":"","mcity":"SWANVILLE","mstate":"ME","mzip":"04915","pcpfaxno":2079306709,"pcpnpi":1023009388,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6HJ7A01GQ57","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N411","Z0100","S46011A","M7541","S46011D","M7501","M75101","I2510","Z98890","Z0000","Z87440","N401","N138","G8918","M75121","M19011","Z1389","Z125","W19XXXA","F17200","Z23","E1165","J449","K8020","Z122","F17210","R918","Z87891","G2581","M25511","I25110","I213","L570","I739","I10","S301XXS","I2121","N390","E782","I080","R931","M7981","I700","L7632","R079","M549","I7411","I25810","I97630","I200","Z743","I25728","I25718","I25118","I221","R911","J432","J849","R590","H2511","H2512","R300","R399"],"date":["2023-10-23","2025-10-28","2023-12-19","2023-12-04","2023-12-04","2024-06-10","2024-05-09","2024-12-18","2024-06-10","2023-11-17","2023-10-23","2023-10-23","2023-10-23","2023-12-19","2023-12-19","2023-09-27","2023-09-01","2024-11-20","2023-12-19","2025-09-23","2024-12-04","2025-03-21","2024-07-08","2025-09-23","2024-06-14","2024-06-14","2024-06-14","2024-06-14","2024-06-17","2023-09-27","2022-11-16","2022-10-03","2022-08-18","2022-06-07","2022-05-03","2022-04-21","2022-04-10","2022-04-08","2022-04-08","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-04-06","2022-04-06","2022-04-06","2022-04-08","2022-04-08","2022-04-06","2022-04-06","2022-04-07","2022-04-07","2022-04-07","2022-04-06","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2022-01-26","2022-02-02","2022-02-24","2022-01-17"],"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":[["","","ANORO ELLIPTA","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ALFUZOSIN HCL ER","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","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":""}]}]}