{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charles W Nutter","gend":0,"currentgend":"","add":"313 BEECH RIDGE RD","city":"NORTH BERWICK","state":"ME","zip":"03906","dob":"1953-12-08","age":"","mstatus":"","insh":"10000065308","cliId":"","pno":2076762771,"cno":2076514199,"email":"wtheflow@yahoo.com","ename":"","eno":"","pphy":"DONOVAN, KEVIN","ppno":6037422263,"pcpadd":"PO BOX 412503,","pcpcity":"BOSTON","pcpstate":"MA","pcpzip":"22412503","pcpcounty":"","pcpid":"","pcpname":"WHP ADULT AND CHILDRENS MEDICINE OF DOVER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"313 BEECH RIDGE RD","madd2":"","madd3":"","mcity":"NORTH BERWICK","mstate":"ME","mzip":"03906","pcpfaxno":"","pcpnpi":1801958186,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6XE2DT8DA01","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","H43811","H532","I4891","Z1211","K635","K5730","Z800","I2510","L718","L02821","L02222","L708","H539","I480","M25561","N2889","Z01810","K862","R935","N189","N1832","I10","E785","N400","R9720","K8070","R7989","R1013","K9186","E6601","K819","N401","R9431","I4819","Z98890","R079","D125","N390","R748","Z9049","I340","Z951","N3000","C641","D3001","R739","A6920","R319","R109","R001","H35372","H2513","Z95818","Z0101","I4892","I4430","I493","I4811","C649","R300","M1711","Z96651","D485","D225","L814","L821","L570","L565","S80262A","W57XXXA","K529","D7389","R110","N182","K8020","D0462","H5340","M79641","M1612","K8080","K8000","Z09","N200","N179","G4733","N281","Z01818","R0609","I429","R531","Z006","E669","R4182","M25531","N289","Z8673","I5189","Z952","H5213","Z87891","K8010","Z860101","D6489","E854","I680","N1830","I491","N529","R338","R6889","E782","L820","L538","L298","L0101","D649","L281","R609","N138"],"date":["2025-08-19","2023-02-08","2024-11-25","2025-08-15","2024-03-15","2024-03-15","2024-03-15","2024-03-15","2025-03-07","2023-06-28","2023-12-20","2023-06-28","2023-06-28","2023-06-27","2025-03-07","2023-10-06","2024-02-09","2024-05-23","2025-10-17","2024-08-29","2023-07-07","2025-09-18","2025-09-18","2025-09-18","2025-09-18","2025-10-27","2025-02-19","2023-01-18","2024-08-30","2024-08-29","2024-09-10","2024-09-10","2024-11-05","2024-09-09","2024-05-23","2024-05-23","2024-08-29","2024-03-15","2024-09-21","2023-01-18","2023-06-09","2023-05-23","2023-06-13","2024-05-12","2025-07-21","2023-04-19","2024-09-26","2023-06-12","2024-05-14","2024-05-12","2025-08-22","2024-11-25","2024-11-25","2025-03-07","2024-12-16","2023-05-05","2023-05-05","2023-05-05","2023-05-05","2023-06-09","2024-05-10","2025-07-29","2025-09-25","2023-12-20","2023-12-20","2023-12-20","2024-01-17","2024-01-17","2023-12-20","2023-06-12","2023-06-12","2024-03-15","2024-08-29","2024-08-29","2023-06-08","2025-02-07","2024-01-17","2023-11-14","2022-12-01","2023-10-27","2024-08-30","2024-09-12","2024-09-12","2024-09-19","2024-09-20","2023-11-21","2023-02-20","2023-04-28","2024-01-31","2024-08-27","2025-09-25","2023-05-05","2025-02-07","2025-02-07","2025-06-05","2023-11-20","2023-05-05","2023-05-05","2023-05-05","2023-12-13","2025-02-07","2025-02-07","2025-02-03","2024-07-09","2023-04-28","2023-04-28","2024-08-29","2024-08-30","2025-07-18","2024-05-15","2023-01-17","2022-10-12","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-26","2022-08-10","2022-07-20","2022-07-18"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","NEBIVOLOL HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","ALFUZOSIN HCL ER","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","KLOR-CON M20","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","METRONIDAZOLE","","","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":""}]}]}