{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dennis M Greenleaf","gend":0,"currentgend":"","add":"1045 HIGH ST","city":"West Gardiner","state":"ME","zip":"04345","dob":"1948-04-30","age":"","mstatus":"","insh":"10000062675","cliId":"","pno":2075882396,"cno":"","email":"","ename":"","eno":"","pphy":"LIEGNER, ADAM","ppno":2075826608,"pcpadd":"4 HORTON PL,SUITE 101","pcpcity":"TOPSHAM","pcpstate":"ME","pcpzip":"40861747","pcpcounty":"","pcpid":"","pcpname":"GARDINER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1045 HIGH ST","madd2":"","madd3":"","mcity":"West Gardiner","mstate":"ME","mzip":"04345","pcpfaxno":2075822258,"pcpnpi":1265793574,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3XE6NY3MW79","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J441","M9903","M5450","M9902","M546","I110","I509","I2510","Z122","R55","I452","F17210","M67442","F419","E1151","F410","L03116","Z0000","I10","E1169","E785","R6889","S80861A","W57XXXA","Z87891","S40262A","R079","E7849","I5042","R001","K0889","E1129","R0602","U071","E1142","J449","M25512","R918","S90465A","R0600","I517","Z0100","H40052","R531","Z789","E119","R0989","Z7951","Z7952","R7989","R000","S299XXA","G4700","Z23","Z7984","B351","R42","G4733","Z87820","I6523","R809","R350","N400","L602","I088","K5900","Z87440","J439","R062","R2232","I6782","G9389","R569","G319","J811","Z96612","R059","L603","L570","E669","S40022A","S40021A","X58XXXA"],"date":["2024-03-09","2025-03-28","2025-03-28","2025-03-28","2025-03-28","2023-07-10","2023-07-17","2023-09-07","2024-07-18","2024-11-28","2023-08-05","2023-08-05","2025-04-03","2023-12-18","2025-07-09","2023-11-13","2025-07-14","2025-10-29","2024-05-01","2024-05-01","2024-05-01","2023-06-22","2024-06-25","2025-07-05","2025-02-11","2023-06-24","2023-06-25","2023-10-12","2023-09-07","2025-07-24","2024-11-28","2023-06-02","2023-07-27","2023-04-22","2025-10-30","2025-04-16","2023-06-23","2024-03-09","2025-07-05","2023-07-18","2023-05-16","2025-06-25","2025-06-25","2023-08-05","2023-08-05","2023-06-12","2023-06-25","2023-06-01","2023-06-01","2023-06-10","2023-06-10","2023-06-10","2023-11-13","2024-10-24","2024-03-18","2025-08-15","2023-08-17","2023-08-17","2023-08-08","2023-09-06","2023-02-15","2023-09-01","2023-10-23","2023-05-17","2025-09-24","2023-09-01","2023-09-01","2023-08-06","2023-07-17","2024-12-19","2023-08-07","2023-08-07","2023-08-07","2023-08-07","2023-06-25","2024-03-09","2024-03-09","2022-10-19","2022-10-19","2022-08-17","2022-08-09","2022-08-09","2022-08-09"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","COMBIVENT RESPIMAT","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}