{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kenneth E Proctor","gend":0,"currentgend":"","add":"4 OLDE FORT RD","city":"CAPE ELIZABETH","state":"ME","zip":"04107","dob":"1947-07-27","age":"","mstatus":"","insh":"10000066245","cliId":"","pno":2077670788,"cno":"","email":"kproctor27@yahoo.com","ename":"","eno":"","pphy":"DOBIESKI, STEVEN T","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4 OLDE FORT RD","madd2":"","madd3":"","mcity":"CAPE ELIZABETH","mstate":"ME","mzip":"04107","pcpfaxno":2078741483,"pcpnpi":1942279617,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4H99H68VA28","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C4441","Z98890","S76111D","Z96611","M19011","N200","I10","E785","R4182","M1711","M1712","H401131","E1165","E7800","E1121","E119","M25411","M25711","C44719","M25511","N201","N135","S8991XD","S0003XA","S199XXA","E1142","B351","L84","Z23","S76111A","G8918","L97522","R911","E118","M25561","E1159","M79671","M79672","M79604","W108XXA","E8720","W1849XA","R319","E1129","E1140","N132","M75111","M94211","E1169","N202","R197","S0101XA","H26491","K5790","N3289","E8352","M51360","M47816","M4316","Z7984","Z0000","R6889","R296","N182","M5450","S76119A","N400","M25552","R4189","E875","L603","M160","Z713","Z0001","L989","H5202","Z466","S76191D","I499","M533","S0990XA","W19XXXA","N402","M1990","L578","Z85828","I129","S8991XA","D485","Z87442","R918","J8410","S46001S","M5416","E138","R2681","E1342","S8492XS","S90822A","Z20822","H903","Z09","Z961"],"date":["2025-08-18","2023-09-18","2023-08-10","2025-07-17","2024-10-30","2025-11-18","2024-07-26","2024-07-26","2023-07-24","2025-02-21","2025-02-21","2025-11-05","2024-02-22","2025-01-16","2025-08-21","2025-11-05","2024-07-02","2024-07-02","2023-06-14","2024-03-26","2023-06-29","2023-06-29","2024-12-16","2024-12-15","2024-12-15","2025-10-30","2025-10-30","2025-10-30","2025-09-15","2023-04-04","2024-07-26","2025-05-05","2025-08-04","2023-03-20","2023-03-20","2025-01-03","2024-12-20","2024-12-20","2025-01-17","2023-02-17","2023-06-16","2023-02-18","2023-06-19","2023-10-09","2023-10-09","2023-06-18","2024-07-26","2024-07-26","2025-04-24","2023-07-24","2024-12-09","2024-12-15","2024-06-07","2024-09-06","2025-04-08","2024-09-18","2025-01-03","2025-01-03","2025-01-03","2023-02-18","2024-09-17","2023-01-01","2023-02-21","2023-05-30","2025-01-17","2023-02-19","2023-02-19","2024-01-11","2025-01-16","2024-02-25","2023-02-17","2024-01-11","2025-11-18","2023-05-12","2023-05-12","2023-02-10","2023-07-31","2023-04-01","2024-03-20","2024-03-21","2024-12-15","2024-12-15","2023-07-31","2023-07-24","2023-06-13","2023-07-24","2023-07-24","2023-02-17","2025-06-05","2023-10-23","2024-08-29","2025-08-04","2022-09-23","2022-09-26","2022-09-26","2022-08-24","2022-08-24","2022-08-24","2022-08-17","2022-07-05","2022-04-21","2021-10-21","2022-02-01"],"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":[["","","GLIPIZIDE ER","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","DICLOFENAC POTASSIUM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ASSURE PRISM MULTI","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2021-22","","","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":""}]}]}