{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael F Esty","gend":0,"currentgend":"","add":"5 LOCKE ST","city":"FALMOUTH","state":"ME","zip":"04105","dob":"1953-10-03","age":"","mstatus":"","insh":"10000062318","cliId":"","pno":2077815205,"cno":2078381385,"email":"195buaa811@gmail.com","ename":"","eno":"","pphy":"MCELHINNEY, KRISTINA E","ppno":2078469013,"pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 LOCKE ST","madd2":"","madd3":"","mcity":"FALMOUTH","mstate":"ME","mzip":"04105","pcpfaxno":2078741483,"pcpnpi":1497073746,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5PH5Q90WD77","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z122","M25521","Z87891","I739","M65342","M65341","R0789","R042","H04123","E7849","M79606","H2513","K5900","S61211A","S66321A","W298XXA","G5601","M79662","R2689","H539","R2681","R109","M65331","M65332","M25552","U071","J189","E785","I080","R9439","R490","J3489","J342","J343","J321","M2550","R002","Z0000","R222","Z23","D485","Z0001","R1310","R202","M79605","B029","N401","E7800","E1136","D6851","E559","M542","F17200","J40","E1159","F419","R3129","J329","H43813","H353131","E119","M50322","M47812","M4312","R918","J984","R1312","F331","E1169","J440","E1165","R350","R102","Z125","F17210","Z0100","Z720","R6889","I10","R059","R030","J449","J209","G43109","L570","Z6832","J323","J322","J320","I340","R0602","I517","I871","H903","M6281","M79641","M79644","G43909","R2231","M25431","K219","R0600"],"date":["2024-08-20","2023-09-22","2024-08-20","2023-09-28","2024-12-06","2024-12-06","2024-08-27","2024-03-21","2024-08-20","2024-07-01","2023-03-21","2023-03-14","2023-02-28","2023-09-25","2023-09-22","2023-09-22","2024-05-06","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2023-02-28","2024-05-09","2024-05-09","2023-09-28","2023-02-23","2023-02-23","2023-03-21","2024-08-05","2024-08-13","2023-10-25","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-03-21","2024-07-03","2024-10-01","2024-07-03","2025-10-20","2023-09-22","2025-10-20","2023-09-22","2025-05-09","2023-09-22","2024-12-18","2025-10-17","2025-10-17","2025-10-17","2025-10-17","2025-10-17","2025-04-22","2023-06-29","2023-01-16","2023-01-16","2023-06-29","2024-09-25","2025-04-21","2023-09-12","2023-09-12","2025-11-07","2025-04-22","2025-04-22","2025-04-22","2022-12-16","2022-12-16","2023-10-25","2023-06-29","2023-06-29","2023-06-29","2024-01-05","2023-10-24","2023-10-24","2024-02-01","2024-02-01","2024-12-17","2022-12-21","2022-11-22","2022-09-19","2022-09-13","2022-09-29","2022-08-29","2022-08-29","2022-08-10","2022-05-05","2022-05-05","2022-04-07","2022-04-07","2022-03-17","2022-02-28","2022-02-28","2022-02-28","2022-02-28","2021-12-14","2021-11-30","2021-11-30","2021-11-30","2021-12-01","2021-11-16","2021-11-16","2022-02-04","2022-02-09"],"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":[["","","TRAZODONE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","RIZATRIPTAN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","TEMAZEPAM","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LISINOPRIL","","","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":""}]}]}