{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David A Coomer","gend":0,"currentgend":"","add":"498 VARNUMVILLE RD","city":"BROOKSVILLE","state":"ME","zip":"04617","dob":"1954-03-17","age":"","mstatus":"","insh":"10000067235","cliId":"","pno":2073268016,"cno":"","email":"notgoog68@gmail.com","ename":"","eno":"","pphy":"JARVIS, BETHANY L","ppno":2073742311,"pcpadd":"PO BOX 587,","pcpcity":"AUGUSTA","pcpstate":"ME","pcpzip":"43320587","pcpcounty":"","pcpid":"","pcpname":"ELLSWORTH FAMILY PLANNING AND PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"498 VARNUMVILLE RD","madd2":"","madd3":"","mcity":"BROOKSVILLE","mstate":"ME","mzip":"04617","pcpfaxno":2073743984,"pcpnpi":1144262791,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4YV0M45MV41","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","Z79899","E7800","Z6826","F17200","N400","R9720","Z1330","Z6825","Z125","N401","M25531","M109","F17210","Z1331","N138","M79641","Z0100","D3132","Z0000","E785","F4321","Z7189","Z122"],"date":["2025-08-20","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2025-04-22","2025-06-03","2025-04-16","2025-04-16","2024-12-11","2025-04-07","2025-01-06","2025-01-06","2025-01-06","2024-12-11","2025-03-31","2024-12-04","2023-05-02","2023-05-02","2023-06-09","2023-06-09","2022-08-10","2022-08-10","2022-09-01"],"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":[["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","AFLURIA QUAD 2022-23 (3YR UP)","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MODERNA 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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}