{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George T Delorme","gend":0,"currentgend":"","add":"33 OAK DR","city":"GRAY","state":"ME","zip":"04039","dob":"1953-12-17","age":"","mstatus":"","insh":"10000064880","cliId":"","pno":2073935906,"cno":"","email":"GEORGE.DELORME@OUTLOOK.COM","ename":"","eno":"","pphy":"MCBRADY, MEGAN E","ppno":2078469013,"pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1934","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":2075238586,"pcpnpi":1164868964,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3MX6HW9JV73","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E139","I10","E785","E6601","M9905","M533","M9901","M542","Z0000","H6090","M461","H532","E1165","Z794","E669","E1065","E1069","H60332","Z136","Z87891","E10649","H4922","E11319","Z720","R768","H903","E871","Z0101","Z23","S39012A","E11311","G9389","I63233","M5450","M5417","Z125","M109","M5416","M4726","R7989","F3341"],"date":["2024-05-08","2023-10-05","2023-10-05","2023-10-05","2025-08-20","2023-06-15","2025-08-20","2025-08-20","2024-06-11","2023-07-27","2025-08-20","2024-09-26","2023-05-31","2024-09-26","2023-05-30","2024-08-15","2024-08-15","2024-08-05","2024-08-05","2024-08-05","2024-03-14","2024-09-26","2024-09-26","2024-08-05","2023-05-01","2024-09-05","2023-05-08","2024-09-12","2024-09-16","2024-09-16","2023-06-05","2024-09-11","2024-09-10","2022-11-15","2022-11-15","2022-10-21","2022-10-21","2022-10-04","2022-09-29","2022-04-28","2022-04-28"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","NOVOFINE 32","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","ULTRA-FINE MICRO PEN NEEDLE","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","CAREFINE PEN NEEDLE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","GLIPIZIDE XL","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(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":""}]}]}