{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wilfred M Begin","gend":0,"currentgend":"","add":"32 LILY LN","city":"NEW GLOUCESTER","state":"ME","zip":"04260","dob":"1953-11-15","age":"","mstatus":"","insh":"10000063417","cliId":"","pno":2077542731,"cno":"","email":"","ename":"","eno":"","pphy":"FACENDOLA, WARREN","ppno":2077955700,"pcpadd":"Central Maine Internal Medicine,12 High St Ste 400","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"42407027","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"32 LILY LN","madd2":"","madd3":"","mcity":"NEW GLOUCESTER","mstate":"ME","mzip":"04260","pcpfaxno":"","pcpnpi":1619518719,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1PX4AT3HX75","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I429","I2510","G5622","M1711","K429","M25569","M542","Z0000","R079","M47816","M5136","M549","E119","I10","E782","G4733","R6889","I2582","Z0101","M47814","R400","Z7689","E139","R5383","M62830","E785","E538","G5620","I219","H40013","F32A","R600","J40","R059","U071","Z136","R0789","R9439","I4510","Z01818","I499","K219","I7120","G44219","L309","Z8249","F329"],"date":["2024-10-02","2025-06-17","2025-03-13","2024-09-27","2023-10-11","2024-08-29","2025-07-23","2024-07-18","2025-01-02","2023-04-10","2023-04-10","2024-11-12","2025-06-18","2025-06-18","2024-10-16","2023-10-30","2023-12-30","2024-10-23","2024-10-30","2023-04-10","2023-06-09","2023-09-01","2024-10-16","2025-01-06","2025-06-18","2025-06-18","2025-04-30","2025-04-08","2024-09-12","2023-07-11","2023-10-30","2024-11-13","2025-03-26","2025-03-26","2023-12-29","2023-03-30","2024-04-18","2024-10-10","2024-04-18","2024-12-20","2024-11-15","2023-09-01","2024-12-23","2023-04-04","2023-04-04","2024-11-12","2023-04-04"],"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":[["","","TRAMADOL HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","RANOLAZINE ER","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","FREESTYLE FREEDOM LITE","","","Select","Select",""],["","","BETAMETHASONE VALERATE","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}