{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas W Curtis","gend":0,"currentgend":"","add":"252 ALLEN RD","city":"HEBRON","state":"ME","zip":"04238","dob":"1952-10-26","age":"","mstatus":"","insh":"10000064250","cliId":"","pno":2077510228,"cno":"","email":"thomcurtis.housewright@gmail.com","ename":"","eno":"","pphy":"RICHARDS, SAMANTHA","ppno":2077984050,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"252 ALLEN RD","madd2":"","madd3":"","mcity":"HEBRON","mstate":"ME","mzip":"04238","pcpfaxno":2077984018,"pcpnpi":1689960114,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7WH6Y53EH61","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":["I480","I10","E7849","M5450","M5412","M25512","M9900","M9901","M9902","M9903","M546","M5441","S72141D","R202","E559","R5383","Z136","E039","J189","R0602","R059","J101","J9811","J069","M542","S728X1A","S72001A","Z0101","H8110","J36","I4891","J0390","G4733","M9701XA","M25551","M47816","Z471","R221","M7989","I6529","J029","B9689","S72141A","Z96641","R918","I2510","K8020","R0683","G4710","R0681","Z23","R21","R400","M1990","Z0001","R0782","M47812","M5442","M978XXA","R0781","S2231XA","U071","Z8616","Z1211","K5730","K649","E785","T8484XA","R911"],"date":["2025-11-17","2025-11-17","2025-11-17","2025-03-25","2025-11-07","2023-10-16","2025-06-03","2025-06-03","2025-06-03","2025-06-03","2023-08-21","2025-02-12","2024-06-28","2023-03-29","2024-11-06","2024-11-06","2024-11-06","2024-11-06","2025-03-03","2025-02-05","2025-02-05","2025-02-05","2025-08-10","2025-02-11","2024-04-24","2024-03-27","2024-02-17","2025-04-07","2025-05-05","2023-08-08","2024-04-25","2023-08-05","2024-03-19","2024-02-29","2024-02-17","2024-02-17","2024-02-17","2023-08-05","2023-08-05","2023-08-05","2023-08-05","2023-08-05","2024-03-08","2024-02-29","2025-08-10","2025-08-10","2025-08-10","2024-01-16","2024-01-16","2024-01-16","2023-03-31","2023-11-16","2023-11-16","2023-11-16","2023-03-31","2025-03-11","2025-06-13","2023-03-29","2024-02-17","2025-08-10","2025-08-10","2022-10-22","2022-10-22","2022-09-16","2022-09-16","2022-09-16","2022-09-16","2022-08-03","2022-08-31"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}