{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Albion R Huntley","gend":0,"currentgend":"","add":"3 CARLISLE WAY","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1947-04-21","age":"","mstatus":"","insh":"10000064851","cliId":"","pno":2074155046,"cno":"","email":"","ename":"","eno":"","pphy":"EMERY, PETER","ppno":2077745816,"pcpadd":"100 FODEN RD WEST,STE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 CARLISLE WAY","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078741483,"pcpnpi":1649239765,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1J13QP6GM09","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J300","L400","L720","L821","D1801","Z0001","R2689","R2681","H903","K219","K259","G5602","D492","D0471","E785","K2100","K2960","L814","G629","M792","R202","M25632","M25642","M25532","M79642","J324","J329","R6889","G4733","M25512","M6281","M25612","H43393","Z0100","L03115","D485","Z0101","G253","M7552","Z23","R7989","I480","S81811A","Z1211","D120","Z860101","D123","L570","S81801A","D0472","G609","R252","G5603","Z0000","Z03818","J069","J029","R0602","M19012","I2510","I951","M79675","L708","M62541","M62542","M25531","R399","E871","Z20822","L03032","Z86010","D122","S91011A","L0390","Z4802"],"date":["2025-03-05","2025-06-24","2024-12-17","2025-06-24","2025-06-24","2024-11-22","2025-06-25","2025-06-25","2023-12-19","2024-02-29","2024-02-29","2025-05-02","2025-06-24","2025-10-29","2024-11-22","2023-12-19","2023-12-19","2025-06-24","2025-05-13","2025-05-13","2024-08-14","2025-03-03","2025-03-03","2025-03-03","2025-03-03","2025-03-05","2024-04-27","2023-01-01","2025-05-14","2022-12-06","2022-12-06","2022-12-06","2024-02-12","2024-01-10","2025-08-28","2023-05-18","2025-01-13","2023-11-08","2022-12-07","2024-09-12","2024-02-20","2024-11-22","2025-07-17","2025-03-11","2025-03-11","2025-03-11","2025-03-11","2023-07-27","2025-07-23","2025-07-23","2022-11-02","2022-11-02","2022-11-02","2022-11-03","2022-10-05","2022-10-05","2022-10-05","2022-08-26","2022-08-11","2022-08-26","2022-07-21","2022-05-25","2022-04-13","2021-12-06","2021-12-06","2021-12-06","2021-11-01","2021-11-17","2021-11-16","2021-12-14","2021-12-13","2021-12-13","2021-12-29","2022-01-06","2022-01-06"],"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":[["","","CALCIPOTRIENE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","CEFADROXIL","","","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":""}]}]}