{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vincent Decesere","gend":0,"currentgend":"","add":"123 SCHOOL ST APT 110","city":"Gorham","state":"ME","zip":"04038","dob":"1938-09-04","age":"","mstatus":"","insh":"10000064137","cliId":"","pno":2078038776,"cno":"","email":"","ename":"","eno":"","pphy":"JOHNSON, JESSICA","ppno":2078392559,"pcpadd":"Martins Point Health Care,575 Main St","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"123 SCHOOL ST APT 110","madd2":"","madd3":"","mcity":"Gorham","mstate":"ME","mzip":"04038","pcpfaxno":"","pcpnpi":1477001501,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7EC9UC0VF24","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5321","F0390","J9601","L600","B351","I7389","E119","M79622","E782","R0609","R413","L602","R262","F03C0","I10","R52","R4182","W19XXXA","I6782","G309","R4189","Z23","N400","Z043","R509","R410","R059","R9389","I6523","M4802","H11812","R531","G9389","G319","J189","M25531","R930","K760","R0902","K449","R2689","S83501A","R32","R41841","M79674","E1142","G990","M79641","I700","S63501A","R55","Z8546","M79675","L308"],"date":["2023-11-06","2025-03-01","2023-09-15","2024-07-09","2025-06-18","2024-07-09","2025-08-29","2025-03-01","2025-06-17","2025-04-18","2025-03-11","2025-06-18","2025-06-18","2025-03-11","2025-06-17","2025-06-02","2025-06-02","2025-06-02","2024-08-12","2025-07-01","2024-10-08","2023-12-08","2024-10-08","2025-06-02","2025-05-27","2025-05-27","2025-06-02","2025-06-02","2025-06-02","2025-06-02","2022-12-29","2025-03-01","2025-03-01","2025-03-01","2025-06-02","2023-03-27","2023-08-15","2023-08-14","2023-08-14","2023-08-14","2024-10-11","2023-03-27","2023-04-10","2025-08-23","2023-06-21","2025-06-18","2025-06-18","2023-03-27","2023-08-14","2023-03-27","2023-08-16","2023-06-05","2022-10-12","2022-10-12"],"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":[["","","JARDIANCE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","DONEPEZIL HCL","","","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":""}]}]}