{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Albert G Ayre","gend":0,"currentgend":"","add":"551 SOUTH SHORE DR","city":"RANGELEY","state":"ME","zip":"04970","dob":"1942-02-04","age":"","mstatus":"","insh":"10000065913","cliId":"","pno":2072329011,"cno":"","email":"layre1942@gmail.com","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":2077745816,"pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 13","madd2":"","madd3":"","mcity":"RANGELEY","mstate":"ME","mzip":"04970","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8Q92X60KC89","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E291","M25551","D509","Z0001","F419","R0609","I10","I2510","M25552","R293","M6281","R2689","J432","J479","R918","D649","J449","R6889","R079","I2089","L570","F5221","N401","R102","Z125","D122","E785","E559","R200","R042","L820","L578","L814","L821","Z23","K922","K219","Z85828","D492","H9202","M160","C44629","Z951","I4949","I350","R0600","E236","R399","Z1211","R195","K648","J069","I25118","Z0100","I083","R931","R0602","R55","J849","J984","J8489","M1612","M7062","T1591XA","R1030","S76212A","J8410","Z9861","C44719","Z0101","M1611","M47816","H04123","J439","N138","U071","I700","R0789","I499"],"date":["2025-09-26","2025-09-23","2023-10-28","2024-11-15","2023-10-27","2025-03-12","2025-07-10","2024-09-18","2025-08-13","2024-12-31","2024-12-31","2024-12-31","2024-11-01","2024-11-01","2024-11-01","2023-12-05","2025-09-11","2023-01-01","2025-11-19","2025-03-12","2025-09-11","2025-09-26","2025-09-26","2025-09-26","2024-05-07","2023-12-05","2024-11-15","2024-11-15","2024-11-15","2024-01-04","2023-11-13","2025-09-11","2025-09-11","2025-09-11","2025-09-30","2023-12-05","2023-12-05","2025-09-11","2025-09-11","2025-01-22","2025-08-13","2023-01-31","2025-04-10","2025-04-10","2025-04-10","2025-03-10","2024-01-19","2023-08-04","2023-12-05","2023-12-05","2023-12-05","2023-09-30","2025-04-08","2025-02-07","2025-03-14","2025-03-14","2025-03-14","2025-03-10","2024-11-01","2024-01-19","2025-09-11","2025-09-23","2024-08-26","2023-05-17","2023-09-14","2023-09-14","2025-03-10","2023-05-17","2025-09-11","2023-12-15","2025-09-23","2025-09-23","2023-05-18","2022-10-21","2022-10-21","2022-05-26","2022-05-26","2022-01-29","2022-01-29"],"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":[["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PIRFENIDONE","","","Select","Select",""],["","","IRBESARTAN","","","Select","Select",""],["","","TESTOSTERONE","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","IRBESARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","ALFUZOSIN HCL ER","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","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":""}]}]}