{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lewis W Kingsbury","gend":0,"currentgend":"","add":"31 NARROWS RD","city":"NOBLEBORO","state":"ME","zip":"04555","dob":"1954-02-17","age":"","mstatus":"","insh":"10000066180","cliId":"","pno":2075302826,"cno":"","email":"kingsburyk@hotmail.com","ename":"","eno":"","pphy":"STEELE, ERIK N","ppno":"","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 156","madd2":"","madd3":"","mcity":"NOBLEBORO","mstate":"ME","mzip":"04555","pcpfaxno":2078287850,"pcpnpi":1538176789,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4K33KT9QG07","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":["Z5111","D7589","Z5112","I361","I517","I5189","I499","R7989","M79671","M109","I4819","Z7901","C9000","D472","L308","I480","T887XXA","M5431","M546","I429","I4729","H903","I4891","I4720","I498","D225","Z85820","L814","L578","K219","E785","R4182","M160","H40013","R233","I491","U071","J029","R059","D333","J300","D892","L309","E8339","R2242","R051","R779","I87323","M25562","L570","M25561","H6123","J020","R9431","Z515","Z538","I081","D229","Q248","Z136","Z23","E870","Z0100","Z125","R5381","R509","R079","L821","E869","R070","G319","R0789","M48061","M5116","M4726","M4316","D849","R0602","M25559","Z130","Z13228","Z13220"],"date":["2025-08-12","2024-05-13","2025-10-07","2023-11-09","2024-04-15","2023-10-06","2023-10-06","2024-05-13","2024-03-25","2024-03-25","2025-05-12","2025-05-12","2025-11-03","2025-03-07","2025-03-19","2025-10-01","2025-06-03","2024-12-23","2023-10-03","2025-10-01","2025-02-03","2025-02-21","2023-10-30","2023-10-30","2023-10-30","2024-11-22","2024-11-22","2024-11-22","2024-11-22","2025-05-12","2025-05-12","2025-05-12","2024-09-06","2025-11-12","2022-12-02","2025-05-12","2024-01-11","2023-02-16","2025-04-28","2025-06-16","2025-06-16","2023-11-04","2024-03-08","2025-09-23","2024-06-04","2025-04-23","2023-10-20","2023-09-06","2024-09-06","2024-11-22","2024-09-06","2025-06-16","2025-04-21","2025-05-07","2025-02-13","2024-04-22","2024-01-03","2025-09-30","2023-11-09","2024-10-18","2025-09-18","2024-09-19","2025-07-16","2023-10-20","2024-01-11","2024-01-11","2025-04-29","2024-07-16","2023-05-06","2023-05-06","2023-05-06","2023-11-17","2024-12-23","2024-12-23","2024-12-23","2024-12-23","2025-04-23","2025-04-23","2024-09-05","2022-10-07","2022-10-07","2022-10-07"],"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 SUCCINATE","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","LENALIDOMIDE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","REVLIMID","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","ATOVAQUONE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","CLOBETASOL EMOLLIENT","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)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":""}]}]}