{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul R Cullinan","gend":0,"currentgend":"","add":"64 SPILLER HILL RD","city":"RAYMOND","state":"ME","zip":"04071","dob":"1952-07-03","age":"","mstatus":"","insh":"10000067298","cliId":"","pno":3014427425,"cno":"","email":"prcullinan@yahoo.com","ename":"","eno":"","pphy":"Kazimierczak, Adam M","ppno":2075351340,"pcpadd":"75 GRAY RD,","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"41052010","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"64 SPILLER HILL RD","madd2":"","madd3":"","mcity":"RAYMOND","mstate":"ME","mzip":"04071","pcpfaxno":2075351358,"pcpnpi":1467459032,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1GE7AM4RD64","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R9720","M25571","M25511","Z0101","M75111","M19011","M19072","M19071","K2100","C61","N401","N4289","L821","D492","M25572","M7541","M79621","M25611","M6281","R6889","M24811","E785","D044","L578","D225","L400","L4059","L570","I10","Z0000","Z0100","S30860A","W57XXXA","Z1211","D125","K5730","K648","R1310","H8110","D2372","L550","D2371"],"date":["2024-03-21","2023-07-07","2025-04-30","2024-08-19","2025-04-30","2025-04-30","2023-07-07","2023-07-07","2023-08-25","2025-05-08","2025-03-27","2022-11-09","2024-10-24","2024-10-24","2023-07-05","2025-04-30","2024-03-08","2024-03-08","2024-03-08","2023-03-11","2024-11-14","2025-05-08","2024-11-05","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2025-05-08","2025-05-08","2023-08-15","2025-05-22","2025-05-22","2023-08-25","2023-08-25","2023-08-25","2023-08-25","2023-08-25","2025-06-12","2022-06-20","2022-06-20","2022-06-20"],"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":[["","","ATENOLOL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","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":""}]}]}