{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Frederick J Reinholt","gend":0,"currentgend":"","add":"97 WAITE HILL RD","city":"CORNVILLE","state":"ME","zip":"04976","dob":"1949-08-01","age":"","mstatus":"","insh":"10000062955","cliId":"","pno":"","cno":2074319569,"email":"declined@10152025.com","ename":"","eno":"","pphy":"MALYK, TIMOTHY C","ppno":2074743320,"pcpadd":"Redington Family Practice,46 Fairview Ave Ste 111","pcpcity":"Skowhegan","pcpstate":"ME","pcpzip":"04976","pcpcounty":"","pcpid":"","pcpname":"REDINGTON FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"97 WAITE HILL RD","madd2":"","madd3":"","mcity":"CORNVILLE","mstate":"ME","mzip":"04976","pcpfaxno":2074749261,"pcpnpi":1225035512,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7A43C78MY82","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0781","Z8546","Z8042","Z8041","Z510","C61","L570","C44619","R32","Z5111","R059","D485","D225","L821","L814","L309","Z0000","D1801","Z7189","Z923","Z79818","Z9079","R9720","Z08","E042","C44519","D0359","L728","R9721","M47819","R109","L608","L538","K5730","K469","C44612","D0439","R1032","R21","D440","E041","L738","Z01812","Z01810","Z0189","N529","M19071","M19072","N400"],"date":["2023-08-30","2025-07-14","2023-09-01","2023-09-01","2025-01-07","2025-01-27","2025-11-17","2023-11-21","2024-04-16","2025-01-27","2024-04-25","2025-05-09","2025-05-09","2025-11-17","2025-11-17","2024-11-05","2025-02-12","2025-11-17","2025-11-17","2025-07-14","2025-01-27","2025-07-14","2024-10-11","2025-07-14","2025-08-28","2025-05-22","2024-12-04","2025-05-09","2024-10-01","2024-09-27","2024-12-09","2023-11-10","2023-11-10","2025-09-02","2025-09-02","2023-11-10","2023-11-10","2025-09-08","2022-10-25","2022-11-21","2022-11-15","2022-11-14","2022-11-22","2022-10-21","2022-09-27","2022-07-19","2022-07-15","2022-07-15","2022-06-28"],"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":[["","","AREXVY","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","SODIUM FLUORIDE 5000 PLUS","","","Select","Select",""],["","","SILVER SULFADIAZINE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","TROSPIUM CHLORIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","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":""}]}]}